The reaction in certain quarters to the healthcare reform provisions of the stimulus bill now clearing Congress lays bare the nature of opposition to the forthcoming fight for real change in healthcare: It will be viciousness at the top of the lungs. It will be a scorched-earth campaign. Its main weapon will be fear. It will be unencumbered by any actual knowledge, subtlety, awareness of history, or access to the thoughts of people who actually know what they are talking about. Its fury will be unloaded not just in service of narrow and inflexible political nostrums, but in the service of sectors of the industry which fear that a truly efficient and effective healthcare system would cripple their profit margins.
The fulminating rages across Rush Limbaugh's radio rants, Matt Drudge's blog, the editorial pages of the Wall Street Journal, and commentaries issued by conservative think tanks, all echoed around the blogosphere. The connections and logical leaps that they consistently make are rather startling to anyone who has been working on the systemic problems of U.S. healthcare for the last few decades. The prime targets of this offensive are comparative effectiveness research, to which the bill allocates $1.1 billion, and help for digitization. The federal government already pours over $300 million per year into comparative effectiveness research – using powerful medical and statistical techniques to determine the most effective and least costly ways to treat disease – through the National Institutes of Health and the Agency for Healthcare Research and Quality. But to Limbaugh and company, actually finding out what works and what doesn't automatically means having committees of government bureaucrats tell your doctor what to do. Research equals socialism. In this frame, digitization, which seemed to work out okay in airport kiosks, grocery stores, and the ATM down at the bank, means something entirely different in healthcare. It means the end of all medical privacy, all ability to choose, and all security in one's access to healthcare.
The irony is that these folks are all about the free market, about choice, about one of America's great skills, shopping. But Americans, and America, are truly dismal shoppers when it comes to healthcare, because we have no idea what we are buying. Neither we nor our proxies (the government, health plans, employers) have any clue what actually will keep us healthy or cure us, who is really good at it, or what it will really cost. As situations go, this is double-plus ungood.
The really sad irony is that we already have, in our system as it works today, every bad outcome these folks are imagining. We already have bureaucrats telling the doctors what they can and cannot do, and telling consumers what doctors they can go to, they're just private bureaucrats working for health plans, informed more by the balance sheet than by effectiveness studies. We already have people's private medical records being used to deny them coverage – by everyone except the government. We already have healthcare rationing, we just do it by ability to pay, by whether you still have a job, and by whether you have been visited by the dread "pre-existing conditions." With our current patchwork of plans tied to employment, many with very high deductibles and co-payments, many subject to rescission when they are most needed, most immune to lawsuit under ERISA, no American under the age of 65 can feel secure in their access to healthcare.
There is a good chance that this toxic brew will be effective. Comparative effectiveness research in political methodology shows that fear and ignorance are a powerful combination when administered in high enough doses. As the debate over the actual healthcare reform bill moves forward, we can expect massive volumes of this combination to be dumped on the public, and on those of us who have been trying to roll this boulder up the mountain for a long, long time.