Why “Populations” Will Love Obamacare

By George Savage | July 19, 2012 | Ricochet

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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