Why "Populations" Will Love Obamacare
Amidst the general excitement at seeing and hearing President Obama off-teleprompter declaiming on the it-takes-a-village school of entrepreneurship, a sober fact: Obamacare is still with us, grinding inexorably towards full implementation. And if you think Obamanomics gives individuals short-shrift, just wait until academic physicians start pushing you around under Obamacare.
Take a peek at what Dr. Ezekiel Emanuel, brother of Rahm, writes in the New York Times:
THE sleek, four-armed "da Vinci" robot has been called a breakthrough technology for procedures like prostate surgery. “Imagine,” the manufacturer says, “having the benefits of a definitive treatment but with the potential for significantly less pain, a shorter hospital stay, faster return to normal daily activities.”
That’s just the kind of impressive-sounding innovation that critics of the health care reform act say will be stifled by the new law, with its emphasis on cost control and the comparative effectiveness of new pills and devices. “Instead of encouraging innovation,”wrote Senator Ron Johnson, Republican of Wisconsin, in The Wall Street Journal, “it stifles creativity.”
The critics are right — if they’re talking about innovations like the da Vinci robot, which costs more than a million dollars and yet has never been shown by a randomized trial to improve the outcomes of prostate surgery
Dr. Emanuel summarizes: "In other words, this is a pseudo-innovation — a technology that increases costs without improving patients’ health."
Physicians used to treat individuals, not averages; informed, not strait-jacketed, by population-based science. Now, as private health expenditures are shifted and aggregated into public budgets, service to the individual is being subordinated to the "greater good" of the "population." Guess who gets to decide?
Since most people are healthy at any given time, individual pain and suffering affects the averages not one whit. This is why Britons love their National Health Service--it performs pretty well on average-- except for those actually chained to the system, as regularly recounted on the pages of the Daily Mail and other British newspapers.
Consider that while each person is infinitely precious in God's sight, he is worth only one vote in a state-run healthcare system. It costs less to purchase re-election with free contraceptives for all than with high-tech surgical robots, which may be why Obamacare is already delivering on the former while preparing to strangle the latter.
So what kind of innovation does Dr. Emanuel find worthy of a future in which smart people like him get to "[direct] capital and creativity away from technologies that don’t improve outcomes or lower costs and toward ones that do?"
A 2006 study showed that a five-item checklist — including hand-washing and cleaning a patient’s skin — could reduce infection rates from intravenous catheters to nearly zero.
I am all for hand-washing. But I am also in favor of high-tech medical advances, including the da Vinci surgical robot. This is not an either-or proposition. As a free citizen living in a still-free country, I demand access to a medical market decentralized enough to accommodate both.
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Comments:
Re: Why "Populations" Will Love Obamacare
"Consider that while each person is infinitely precious in God's sight, he is worth only one vote in a state-run healthcare system."
I don't know that I've ever had occasion to use this phrase before, but the only way I can describe that passage is "chillingly beautiful."
Jun '10
Re: Why "Populations" Will Love Obamacare
Last December I had my prostate removed by a surgeon using a Da Vinci device. The surgery was less invasive, the recovery time is remarkably shorter, and my surgeon told me that he can see far better with the Da Vinci than he could in the old fashioned surgery where you end up with a very long incision.
This so-called "pseudo-innovation" made a real difference (as opposed to, say, a pseudo-difference) in my life.
We cannot turn the health-care system over to this kind of Neanderthal.
Edited on July 20, 2012 at 2:36amMay '12
Re: Why "Populations" Will Love Obamacare
I'm sure similar arguments could have been leveled at the Wright Flier, which cost years of toil and treasure, but only traveled 120 ft in 12 seconds on its first flight. Small minds like Emanuel's could never have envisioned the F-22, the F-117, or even the 747 based on that cold, windy day on a North Carolina beach.
May '10
Re: Why "Populations" Will Love Obamacare
I lived in London for a year and saw, first hand, the horror that is the NHS. I went to a hospital that had a five hour wait in the emergency room (with a friend who had been mugged and was bleeding profusely). The hospital did not have a functioning blood pressure monitor (this was in Chelsea, one of the richest neighborhoods in all of London). I remember one day NHS had a "national cleaning day" where the hospitals would finally turnover all beds (apparently sheets are not cleaned in British hospitals on a daily basis due to the cost of the nurse's union). This was necessary because an epidemic of diseases were running through hospitals at the time which killed otherwise (relatively) healthy individuals. Less than half of hospital beds were cleaned during this national event.
NHS was terrifying. I would not wish these results on our worst enemies.
Edited on July 20, 2012 at 4:11amRe: Why "Populations" Will Love Obamacare
Great point. Medical device innovation is necessarily iterative and empiric in nature. As you surmise, aviation in the pioneering days was quite similar. If you kill off an early innovation as insufficiently cost effective then you also prevent the later refinements, including those mature innovations that today meet with universal approval.
[Full Disclosure: I've been a med-tech entrepreneur these last 23 years]
May '10
Re: Why "Populations" Will Love Obamacare
I saw a heart bypass surgery with the DaVinci robot on Orlive.com. It was amazing, especially when the patient could go home the following day and be on the golf course a week later.
Apr '12
Re: Why "Populations" Will Love Obamacare
The joke made by my vet friends is that their equipment for pets and the level of care far surpasses that for the humans. You can buy pet health insurance too - we did a deal on a business like that which is now public. Funny how the free market supports those businesses that people find necessary. As for the equipment in Canada, it is ancient because where is the benefit in the cost of keeping cutting edge. Medicine only needs to be good enough. As for innovation, let the American do that. What did you say - they are going government health care too - crikey!
Apr '11
Re: Why "Populations" Will Love Obamacare
My father was succesfully treated for bladder cancer by Da Vinci. We met the inventor during my dad's consultation in Manhattan (a fascinating guy). Don't know if this breaks any CoC here, but if I ever meet Dr. Emanuel, he's going to instantly lose all his teeth!!!
On the NHS, I've been frequently traveling to Wales for work the past few months. The car service my company there hires to shuttle people to airports, train stations and hotels is owned by an old-timer, ex-coal miner and we've built up a relationship as he enjoys our conversations. My recent trip last Thurs, he mentioned that he was heading to the hospital for routine follow up for open-heart bypass he had 5 months ago.
It seems he came home from vacation last fall not feeling too well and went to see a cardiologist who recommended 2 stents to clear the arteries. Trouble is, it's a 3 month wait to get stents over there. When he went back, the arteries had calcified and he needed double by-pass.
(cont'd)
Apr '11
Re: Why "Populations" Will Love Obamacare
from #8. I didn't have the heart to tell him 2 things. 1) my mother recently had stents put in and it took her 2 days. 2) he didn't relize it, but this guy was basically triaged. The NHS experts have to know that arteries that require stents are going to get WORSE if not treated. I'm sure they make a calculation that if you actually live long enough to get the damn stents put in, then you qualify for the surgery. They have to know that a certain % are just going to die of cardiac arrest before the stent waiting period is over.
This is truly scary!
Re: Why "Populations" Will Love Obamacare
Having recently undergone robotic prostate surgery, I shudder to think what it would have been like under the old order. Rahm Emanuel's brother is a threat to the health of Americans.
May '12
Re: Why "Populations" Will Love Obamacare
I agree with your final paragraph . No government should restrict access to this or any other outstanding medical technology.
However, the government shouldn't interfere in the market and to try and guarantee affordability. Intuitive Surgical's technology is truly groundbreaking, but like most cutting edge innovations - it isn't cheap.
The amount per procedure to recoup the investment is substantial and may be more than a conventional procedure. Some people may pay for more expensive insurance policies or out of pocket for such procedures, but if we are to allow market forces to work in health care we have to live with the reality that not everyone will be able to afford the procedure Dr. Rahe received.
Dec '11
Re: Why "Populations" Will Love Obamacare
Have they stopped to consider how much of the cost of that robot is regulatory compliance.....
Mar '11
Re: Why "Populations" Will Love Obamacare
Dr. Emanuel is making an excellent case for paying for your own medicine.
If a device like the da Vinci robot is truly a pseudo-innovation, i.e., one which adds to the cost of treatment without improving the outcome (and I'm sure these do exist), then please let it on the market - so that rich people can waste their money on it, demonstrate to the rest of us how useless it is, and discourage the next start-up from trying to foist an unproductive toy on the market.
I say it every time, but it frustrates me to no end that big thinkers like Dr. Emanuel recognize so many problems correctly, understand what the final picture should look like, but somehow miss the most obvious path to get there.
Mar '11
Re: Why "Populations" Will Love Obamacare
tabula rasa: Last December I had my prostate removed by a surgeon using a Da Vinci device. The surgery was less invasive, the recovery time is remarkably shorter, and my surgeon told me that he can see far better with the Da Vinci than he could in the old fashioned surgery where you end up with a very long incision.
This so-called "pseudo-innovation" made a real difference (as opposed to, say, apseudo-difference) in my life.
We cannot turn the health-care system over to this kind of Neanderthal.
Here's the only place I would agree with Emanuel: if your surgery had been paid by Medicare (don't worry, I don't care if it actually was or not), than I sure as heck want to limit what untested expensive toys hospitals are using.
I would hope that all of us want to see most medical care be paid by the patient, but until that day comes, we certainly have a right to demand that hospitals limit their adoption of new technology until it has a track record.
May '10
Re: Why "Populations" Will Love Obamacare
The only important question for Dr. Emanuel is, If you had prostate cancer which approach would you want? Anything he says until he has committed himself to answer that, is pure persiflage.
May '12
Re: Why "Populations" Will Love Obamacare
I don't think the question addresses the issue. His answer most likely is having the procedure done with the Da Vinci. If he asked you whether you would rather fly in first class or coach I imagine you would answer first class - I would.
The questions isn't about what we would like, it is about what we are willing/able to pay.
Too much of the healthcare discussion centers around emotion. We all would like private rooms, every cutting edge treatment, and a chocolate chip cookie that reduces fat and cures cancer, but we can't all afford such things.