Tuesday, February 17, 2009

Preserving the Domestic Tranquility

It seems that the federal government is about to undertake an initiative to evaluate the effectiveness of various modes of treatment. The example used in the article on the subject in The Boston Globe (March 2, 2009) was that of the use of proton beam therapy in the treatment of prostate cancer. The article said that while proton beam therapy is five times as expensive as other forms of radiation, there was no evidence that it is any more effective.

The economic stimulus package contains $1.1 billion for “comparative effectiveness research.” Thanks to heavy lobbying by drug and medical device manufacturers, the law avoids suggesting that the results of the research could be used to reduce the cost of health care.

But, of course, there are suspicious people everywhere. Given the cost pressures being experienced by health care insurers, both public and private, it is not hard to imagine that if proton beam therapy does not prove to be more effective, or even if it turns out to be just a little more so, some of them will refuse to pay for it.

But research is seldom completely conclusive and there will be those who attribute such decision to “putting money over people.” The makers of the equipment will hire special lobbyists and perhaps even take out big ads to promote the therapy. Representatives and Senators from the area in which the equipment is made will introduce legislation requiring health insurance to pay for it.

It’s an example of the implications of national health care financing schemes that make it necessary for decisions like this to be made at the national level and applicable to everyone. The domestic tranquility would seem to be enhanced by decentralizing the matter somewhat so that the resolution reached in Oklahoma might be a little different than it is in Vermont. There will be unhappy people in both places, but it will not be a divisive national issue.

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