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WORTH QUOTING: OBAMA ON THE DECISION MAKERS IN HEALTH CARE.
From his interview with David Leonhardt:
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.
COMMENTS (8)
And then he says right after that:
So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (9) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
Note the choice-- he's saying that CER is for patients. The doc pushes A and its more expensive, we want the patient to know that B is more cost-effective. That's precisely what I've been arguing for a while. That's called consumer-directed health care.
Of course, what isn't said here, is the the CER is likely to lead to different co-pays based on value tiering (Ezra said as much in an earlier post this week), which gives patients financial incentives to engage in their care. Obama highlights the asymmetry, and then goes to say how the government can help reduce that gap.
That's exactly right.
Posted by: wisewon | April 30, 2009 1:22 PM
I was doing a googling to find a quick excerpt and came up on this thread (your post and my response). Generally, it seems we're in violent agreement on this issue of CER, patient choice, decision-making, etc.
http://www.prospect.org/csnc/blogs/ezraklein_archive?month=07&year=2008&base_name=not_rationing_guiding
More importantly, kudos to Obama for similarly having it exactly right.
Posted by: wisewon | April 30, 2009 1:37 PM
Ezra, I find your posts on health care reform to be fantastically informative. If I want more of this type of stuff, what bloggers should I be following? I'd love to hear who you follow.
Posted by: David Edelman | April 30, 2009 2:26 PM
It's so refreshing - and reassuring - to know that such an intelligent, well-informed individual is president. If there's sound policy to be found, chances are he'll find it.
Posted by: BH | April 30, 2009 3:06 PM
Obama has it exactly right. An individual can be a consumer only to a point (take the generic, go to urgent care vs ER, etc). But at some point that individual becomes a patient....and when they do, all consumerism is off. They are in the system and do what they are told. The problem is 80% of the dollars are in the patient category....
As for CER, we (patients and physicians) can't have that data quick enough
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