I have another rant on health insurance in the works, but in the meantime, take a look at what Joshua Holland writes at AlterNet. As we clamor for “single payer” — and I’ve done as much clamoring as anyone, I suspect — keep in mind that very few of the nations with national health care have pure “single payer” systems. Most of them, including France, have systems in which a private health insurance market still functions, I suppose for people who want the hospital suite with gold-plated bathroom fixtures. Whatever.

Anyway, Holland argues there should not be a war between single payer and public option advocates.

Nice health care analysis by the Snarky Penguin.

There are a number of treatments for early-stage, slow-growth prostate cancer. These treatments range from “watchful waiting” — not treating the cancer at all, but just keeping an eye on it — to surgical removal of the prostate gland, to high-tech proton radiation therapy using a proton accelerator. The costs for the various treatments range from a few thousand dollars to hundreds of thousands of dollars.

However, there is little evidence that the more expensive treatments are any more effective than the cheap ones, including watchful waiting. Indeed, for an older patient, watchful waiting makes sense, as there is a high probability he will die of other natural causes before the prostate cancer becomes a problem for him. On the other hand, younger patients, meaning men under the age of 65, might benefit from more aggressive treatment. But which more aggressive treatment?

At the New York Times, David Leonhardt interviews some prostate cancer specialists and finds there is widespread skepticism that the new, expensive, state-of-the-art treatments work any better than older, less expensive treatments.

“No therapy has been shown superior to another,” an analysis by the RAND Corporation found. Dr. Michael Rawlins, the chairman of a British medical research institute, told me, “We’re not sure how good any of these treatments are.” When I asked Dr. Daniella Perlroth of Stanford University, who has studied the data, what she would recommend to a family member, she paused. Then she said, “Watchful waiting.”

Naturally, the health care industry is pushing the more expensive treatments.

And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.

Use of I.M.R.T. rose tenfold from 2002 to 2006, according to unpublished RAND data. A new proton treatment center will open Wednesday in Oklahoma City, and others are being planned in Chicago, South Florida and elsewhere. The country is paying at least several billion more dollars for prostate treatment than is medically justified — and the bill is rising rapidly.

This takes us back to the issue of private insurance companies. Or, should I say, the the medical-industrial complex, which includes private insurance companies? I’ve ranted for years that our system is very good at one thing — creating profitable health care products. Medical treatments that make somebody a lot of money somehow get paid for. But any part of the health care system that can’t be made profitable is allowed to rot.

So, there are billion-dollar investments being made to build prostate cancer proton treatment centers that may or may not be any more successful than older radiation therapies that doctors have been using for years. Or, more successful than doing nothing at all, for that matter.

Meanwhile, just as one example, the nation’s emergency rooms are crumbling into decay. Emergency rooms do not make a profit. They have very high overhead because they have to be ready for, well, emergencies. And many people who use emergency rooms can’t pay the bills. So many hospitals are closing or cutting back or downsizing emergency rooms.

(And the practice of using emergency rooms as default “free” clinics for the poor and uninsured not only adds to the burdens on emergency rooms; it is also probably the least cost-effective way anyone could think of to provide last-ditch health services to the poor and uninsured, which is another big reason our nations spends so much on health care.)

Anyway — it appears that if somebody is making money off a particular gizmo or course of treatment, the health insurance industry manages to find room in its heart to pay for it. However, the private insurance companies routinely refuse to cover people who have even minor “preexisting conditions” and drop customers whose ailments are money-losers.

Put another way, if current trends continue, the day will come when the medical-industrial complex will simply refuse to provide treatments that aren’t making a profit for some part of the medical-industrial complex. And consider that conservatives not only want to kill government-led health care reform; they want the private insurance and other parts of the health-care industry to be even more unregulated and unwatched than they are now, and the government “safety nets” to be dismantled, on the theory that the “free market” fairy will solve our problems, even though there is no place on earth in which 21st-century medical care is being delivered by a “free market” system.

Leonhardt’s interviews show us that when it comes to health care, “profitable” and “effective” do not necessarily find their way into the same ball park. Weirdly, “profitable” and “cost-effective” are not necessarily fellow-travelers, either. That’s because the medical-industrial complex does not make a profit from curing you; it makes a profit from what it call sell to you, whether it cures you or not. And if two treatments are shown by studies to be equally effective, the industry will push the one that provides the higher profit.

Let’s go back to our gentlemen with early-stage prostate cancer. “You have cancer” has got to be among the worst pieces of news anyone ever gets. “You have cancer, but let’s not treat it” doesn’t sound much better, and I understand why some patients would push their doctors into providing some kind of treatment. Leonhardt says a Swedish study on treatment effectiveness recommends removal of the prostate gland for men under age 65. Such surgery can result in sexual dysfunction, however, so I understand why men may want another option. So doctors say, well, there is this new proton-therapy treatment …

One of the reasons the medical-industrial complex gets away with scamming us is that doctors themselves often do not know which treatment is most effective. There is remarkably little effectiveness testing going on. “Drug and device makers have no reason to finance such trials, because insurers now pay for expensive treatments even if they aren’t more effective,” Leonhardt writes. So the doctors often have little else to go on but what the sales reps tell them. And some doctors are as keen to boost their revenue streams as anyone else in the complex.

A critical part of President Obama’s health care proposal is called “comparative effectiveness research (CER).” CER is not, as the Right claims, a plan that would allow the government to countermand a doctor’s decisions based on cost-effectiveness studies. The common claim on the Right that CER is about rationing is a lie. The point behind CER is to fund the kind of effectiveness testing that is not being done now and provide that information to doctors and patients, so that doctors and patients can make more informed decisions about what course of treatment to pursue. (See also what Dr. Howard Dean says about CER.)

Of course, if CER becomes government policy, all those billions of dollars being invested to build proton accelerators to treat prostate cancer might not bring much of a return, which brings me to my last point.

Whenever I publish something about health care I get comments claiming that the private, for-profit health care industry is always better than “the government,” all we need is tort reform, blah blah blah, or that government (as opposed to the health insurance industry?) shouldn’t be involved in health care decisions. I agree with the latter; the government shouldn’t be involved in health care decisions, but nobody is saying otherwise.

The mendacious anti-reform talking points repeated ad nauseam by the dittoheads of the Right are generated by a network of right-wing think tanks and other organizations that exist solely to influence public opinion. This network is very good at getting their propaganda uncritically parroted throughout mass media and the Internet, repeated over and over until it becomes “common knowledge.” And in many cases the deep pockets funding those think tanks are also heavily invested in the medical-industrial complex. And round and round it goes …

If you are in the mood to argue with somebody today, please take on this guyfor me. Here is my response, and his retort to my response. Notice that SH doesn’t address my response at all — they never do — but just spews out standard talking points.

Last week in “Restating the Obvious” I quoted Erick Erickson of RedState:

Jay Rockefeller, Ted Kennedy, Barack Obama, and a host of liberal writers admit that the government will determine whether or not to treat you based on whether the government thinks the cost/benefit analysis makes sense.

And I asked if anyone knew were Erickson got such an off-the-wall idea. Well, I stumbled across the “source” yesterday. Harold P of Democracy for America says the righties are scrambling what’s called “comparative effectiveness research (CER).”

What is CER? Dr. Howard Dean explains:

At issue is something called “Comparative Effectiveness Research” which basically means giving your doctor access to the latest research on what treatments and therapies work and which don’t. This also helps doctors know which treatments are more expensive than others, and helps both patients and doctors decide if there is a cheaper treatment that is just as effective. As a doctor and the husband of a doctor, I know how important it is to have solid scientific research to make critical decisions for my patients.

This research will help doctors choose the best treatment for their patients’ situation and help them make more informed choices rather than risk prescribing less effective or even potentially harmful treatments.

Essentially, in order to control costs and provide patients with better care as we reform health care, the Federal Government will fund and disseminate research that evaluates the effectiveness of different treatments and medicines. This research will give doctors and patients better choices, and most importantly better health care for their money.

This is a common sense idea that should have been put in place a long ago.

Naturally, the Right is against it. Igor Volsky wrote for Think Progress on June 19:

During yesterday’s mark-up of the HELP Committee’s ‘Affordable Health Choices Act,’ Sens. Tom Coburn (R-OK), Pat Roberts (R-KS), Mike Enzi (R-WY) and Orrin Hatch (R-UT) introduced multiple amendments preventing the government from using the results of comparative effectiveness research (CER).

Of course they did. What else would you expect?

Responding to the Republican charges, Sen. Barbara Mikulski (D-MD) pointed out that existing language already prevented the new comparative effectiveness council from using the research to make coverage decisions. …

…The government isn’t mandating that doctors adopt the results of CER and it is not rationing care. Each patient has his or her unique needs and the ultimate decision for how to proceed should be left to the doctor and the patient. Currently, approximately one-third of all treatments have never been proven to produce better outcomes; CER would provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care.

(It seems to me that one of the results of CER might be that doctors do less over-treating and over-prescribing, which the Right has complained about for years. The Right’s complaints are in the context of scare stories about out-of-control malpractice litigation, charging that fear of lawsuits causes doctors to over-treat and over-test, thus running up the cost of medicine. However, this is a charge I’ve been looking into lately, and the “defensive medicine” claim appears to be mostly myth, albeit a myth many doctors believe. Over the past couple of decades several states have passed stringent “tort reform” laws that have drastically reduced the number of lawsuits filed in those states. And guess what? Doctors continue to order as many tests and as many treatments as they did before. But that’s another post.)

So how did the fevered imaginations of righties turn CER into rationing? You can trace that back to a column written in February by Betsy McCaughey. As Harold P at Democracy for America explains, McCaughey’s article is grossly inaccurate. But it established the conflation of CER with rationing, and the Right won’t let go of it.

Paul Krugman:

How bad is it? Let me count the ways.

1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.
2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.
3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.
4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.

See also Ezra Klein

We shouldn’t be surprised that the American Medical Association has come out against government-sponsored insurance plan. The AMA these days has many concerns other than medicine. It is a main proponent of “tort reform,” a vast right-wing conspiracy to enhance corporate profits by denying citizens’ 7th Amendment rights to sue for damages in court.

Although it still pretends to be the voice of American physicians, in fact it has been losing membership steadily for the past several years. The most recent information I could find says that about a third of American physicians are members. It has struggled financially with dwindling membership dues.

The AMA and the American Council of Engineering Companies are co-founders of the American Tort Reform Association (ATRA), which has turned into an umbrella group of special interests and astroturf organizations pushing for tort reform legislation. The ties of “tort reform” to the Right, via Karl Rove, are legendary.

Take, for example, the organization Citizens Against Lawsuit Abuse (CALA), which has chapters in several states actively pushing “tort reform” to state legislatures. According to SourceWatch, CALA is an astroturf organization commissioned by the Philip Morris tobacco company in 1995, and Philip Morris continues to fund and direct CALA through ATRA. SourceWatch says,

A “privileged and confidential” Philip Morris (PM) tort reform budget from 1995shows that PM spent over $16 million to instigate tort reform during that year alone, and that PM paid an international public relations firm called APCO & Associates (now known as APCO Worldwide) almost $1 million in 1995 to implement tort reform efforts behind the scenes.

ATRA promotes CALA on its website (scroll to bottom) as

… citizen activists fed up with the high cost and injustice in our legal system. They work actively within their communities to urge individual responsibility, safety, and to chronicle abuses of the legal system and to fight for civil justice reform.

Yeah, right.

It is ironic that the AMA, which 20 years ago stood up to the tobacco industry by calling for a ban on tobacco ads, is now in bed with it. They’re shacked up in a shabby off-the interstate motel hoping no one finds them, but they’re in bed just the same.