Read this segment of the President's NYT interview:
THE PRESIDENT: ... 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.
NYT: And right now we’re footing the bill for a lot of things that don’t make people healthier.
THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies 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.
NYT: Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —
THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.
Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.
And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.
This is, frankly, a disturbingly Orwellian segment of NewSpeak.
By saying most doctors actually want to do right by their patients, the President is also implying that many do not.
And since there is an asymmetry of information between patients and doctors, government needs to step in and mediate.
But the only example he gives is where a doctor or doctors might be prescribing a medication that's too expensive, and not where a doctor might be under-medicating. Moreover, he's saying that in any system in which the government is spending its own money--Medicaid, Medicare, or some future government-funded system--we have an obligation to get those costs under control.
It's all very sensitively put here: the government is going to open a conversation about what treatment methods work, so that the patients can be better informed.
But the reality is again that if the government is footing the bill, the President expects the government to keep those costs under control, which--ultimately--means the government's ability to intervene in treatment decisions in pretty much the same way that your health insurance company does now.
This is, unfortunately, a carefully crafted piece of anti-intellectualism: doctors are either dupes or tools; you do not have the ability to make your own decisions without help; the government is going to consult people who might know about this stuff and tell you what's good for you.
But, strangely, you're not going to see this parsed anywhere else.