Thursday, July 23, 2009

Human Nature

In his press conference last night, Obama stated that one of the problems with the current cost of medicine is that doctors will see a child with a sore throat and recommend a tonsillectomy, not because it is indicated, but because it has a preferable fee schedule to what is indicated. I'm sure this happens, but I think it's a slander against the medical profession to insinuate it happens often enough to be a concern with the cost of medical care.

Let's assume, for the sake of argument, that the profit motive is so strong that at least a huge minority of doctors recommend costly, but unneeded, procedures on a routine basis purely to increase their billable fees. Does anyone think bureaucrats won't commit the same sins? Is it really a winning argument that we can't trust doctors to make the right decision for the person standing in front of them who can get a second opinion, but an unaccountable bureaucrat hundreds of miles away who gets to make an almost unappealable call for masses of people he will never meet will always make the call with their best interest at heart? Gallup conducts a poll on what professions are viewed as the most trustworthy and ethical every year. In the last poll doctors, nurses, and pharmacists were all in the top ten with the lowest of them having a 6% unfavorable rating. Congressmen were just above used car salesman at 48% unfavorable. They didn't poll for unelected bureaucrats, but I'd have to guess they're near or below officials you can actually vote out of office.

Or is it that doctors have a profit motive, but bureaucrats are only accountable to getting the right answer? I think we know intuitively that this isn't true. Obama previously promised that the government would be hands off in running its new car company, but the same day he called Detroit to promise that they would be staying in expensive office space there and Congress has (predictably) fought tooth and nail to prevent dealer closures in each representative's neighborhood. I don't feel qualified to make a judgment on whether or not the cancellation of the F-22 was militarily advisable, but I'm pretty sure both GA Senators wouldn't have voted against it if Lockheed's F-22 plant was in Marietta, OH.

I'm sure lobbyist groups are already putting together plans to try to get their pet procedure funded under the new government regulations. It would not at all surprise me, for instance, if the bureaucrats deciding what health insurance must cover decide you must pay for other people's abortions if you buy health insurance. At least 12 states already have mandates that require people paying for health insurance to compensate people getting IVF. I'm not saying IVF is the same as abortion, but there are people with moral objections to it and it's certainly not something any sane person would "insure" against. I'm pretty sure at no point in my life will something happen that requires me to get emergency IVF.

So what I really want to know from Obama is, assuming that Doctors are recommending needless procedures (for reasons other than lawsuit protection) so often that there's a quantifiable cost savings to preventing it, are bureaucrats and congressmen just better people than doctors, or is he going to structure the bill so that, for the first time in history, there's no way Washington can tailor their policies to the needs of special or parochial interest instead of the American people?

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