Wanting better health care shouldn’t be conservative or liberal

I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”

For some of us, improving the health care system is more than a passing fancy.  I’m a health services researcher.  It’s my job.  Those people on the TV pay attention to it when it gets ratings, and those people in Washington get into it every other decade or so, but it’s what I do every day.

I really with I could make you believe that I couldn’t care less about the politics of it all.  Seriously.  Yes, like everyone else I care about who is in the White House of Congress, and I do lean different ways on different issues, but – on this I swear – I just want a better health care system.  That’s all.  I don’t care if it’s labeled conservative or liberal.  I don’t care what names you call it.  I just want it to be better.

Specifically, I want it to have phenomenal outcomes, I want everyone to have access to it, and I want it to be cost-effective.

I hope you notice I didn’t say cheap.  I think good things do cost money.  I just wouldn’t like to spend any more than we have to.

People may think I’m closed minded, but I swear I’m not.  I am persuaded by good research.  That’s all.  Evidence.  Data.  Science.  I really don’t have a stake in who “wins” this.  It’s only the final product that matters.

Which brings me back to the title of this post.  I’m heartened by some recent activity I’ve seen.  I watched a debate occur between Austin Frakt and Avik Roy without it degenerating into partisan hackery.  I somehow managed to say a few words on the topic without resorting to sarcasm.  And I believe (maybe I’m delusional) that someone following the whole thread may have seen that it is possible to discuss good, unbiased research in a civil manner.  I stand by this:

I don’t think there is necessarily a right or wrong here.  Research is, more often than not, baby steps.  Each study adds a small amount to our understanding; each study is only so generalizable.

And I’d add that by talking about the body of work that exists, and discussing what from it we can agree on, we could find a starting point for moving forward.  Wouldn’t it be nice if we could devise pilot programs in health care reform in different ways, and then study them?  Agree to the methodology beforehand and then see what happens?  How great would it be if we all agreed to stand by the results, no matter what they might be, no matter what our ideology?

For instance, Avik cites the Medicaid program in Indiana which set up health savings accounts for Medicaid recipients and then coupled them with high deductible health care plans.  Why oh why did they not agree to allow an independent third body to set up a study to see how it worked?  Maybe good research would have shown that reform to be a spectacular success, vindicating the consumer-driven approach.  Maybe good research would have shown that reform to be a spectacular failure, suggesting that such an approach cannot succeed in a high-risk population.

It sure would have been nice to find out.  Instead, too many are driven by a desire to see their pre-chosen method of reform succeed, and so prevent any chance of it being seen in a bad light.  These types of people deny any flaws in a single-payer approach, no matter if such flaws exist.  They refuse to examine the downside of increasing out-of-pocket costs because it might hurt their “side”. They are more interested in the ideology than the goal of improving the health care system.

No good can come of that.

Anyone who reads this blog knows I think highly of Austin.  And, I opened by email this weekend to receive a very nice note from Avik concerning my recent posts.  Those personal contacts really do matter.  They remind me that some of us do have a shared goal – a better health care system.  We may disagree on how best to get there, but we can at least discuss our differences, and – perhaps – look for similarities. This kind of post gives me hope.

I hope this type of debate continues.  For my part, I’m going to keep an eye out for the study that started this all.  When I can finally read the whole thing, I will make sure I tell you what I think.  I’ll tell you if I think it’s a good study (or not), and how I think it adds to our body of knowledge about Medicaid.  And maybe, if more people keep on doing that, we can shift the discussion of health care reform away from politics and back to what really matters.

Aaron E. Carroll is an associate professor of Pediatrics at Indiana University School of Medicine who blogs at The Incidental Economist.

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  • http://www.chrisjohnsonmd.com Chris Johnson

    I agree with what you say. But, at root, we can’t get politics out of this debate. Nor should we. There is a profound and fundamental disagreement over what healthcare is: is it a basic right of all citizens, or is it a commodity to be bought and sold like any other commodity. I suppose we can nibble around the edges of what works and what doesn’t, but I don’t think we can devise the fairest and most workable system until that debate is resolved.

  • Bladedoc

    These hand wringing posts bemoaning the partisanship of the health care debate are hilarious. Once the government controls something (and as much greater than 50% of health care dollars are spent by the government, even before the new reforms I think it’s safe to say they control it) it is by definition political and therefore partisan. It’s like the people who want government control believe that if only Plato’s philosopher-kings ran things it would all be OK. In no country in which the government has such a big role in health care is the management of the system anything but partisan and rancorous from the physician strikes of Germany and France to the whistle blowing and subsequent firings and lawsuits in the NHS.

    Frankly it always sounds as if whoever is saying these things actually means “if only you guys on the other side would shut up I could get this done right”.

  • Healthcare Observer

    If you’re allocating resources among the ‘haves’ and the ‘have-nots’ then to ask for a suspension of ‘politics’ is rather odd, as this is more or less the very definition of politics.

  • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen

    I like this post, and in some ways, I feel for the author. But the author has a particular perspective, a particularly modern one, even though he thinks he doesn’t. Witness his unbiased perspective: “I am persuaded by good research. That’s all. Evidence. Data. Science. I really don’t have a stake in who “wins” this. It’s only the final product that matters.”

    Yet this ‘unbiased’ perspective is actually evidence of a larger bias. It is the bias of the non-philosophical – the person who is not comfortable making large statements about how the world works, despite the overwhelming evidence. The author, in effect, wants us to wake up and view the world as though history began in the last 10-20 years and only peer-reviewed studies of the health care system should be allowed into our thoughts.

    We are not, I suppose, to think about the massive improvement in our lives brought about by capitalism and the industrial revolution. We are not, I suppose, to think about the tremendous productive power to create wealth (for all) that was exhibited by a system (the United States) which respected the rights of the individual; which treated the individuals pursuit of his own happiness as sacrosanct. We should not consider the arguments of Von Mises or even Milton Friedman regarding economic theory and free markets.

    We are not to demand, I suppose, an explanation as to why health care should be viewed as a special case – which would not be subject to the same laws of economics, individual choice, and outcomes as any other part of lives.

    We are to ignore the many experiments of history in countries throughout the world and throughout history which demonstrate that the more control a government has over its people, as a general rule, the less productive and less well they live (not to mention the numerous atrocities these governments are responsible for in the name of the ‘good of the people’).

    Isaac Newton advanced our understanding of the universe – not by keeping his focus too narrow, but by making very large connections and generalizations about the Universe. The same force that makes the apple fall from the tree (gravity), controls the movements of the planets and the stars.

    I understand the author’s lack of comfort with large generalizations, but he cannot expect all of us to so limit our understanding of how the world works.

  • Vious

    The problem is we can’t get politics out of the argument because so many in this country are so blinded that they refuse to have any sort of argument around facts

    It is comical to see so many argue so passionately about Health Care yet they know virtually nothing other than what some extreme blog told them in general terms.

    it makes professionals want to shake their head and scream.

  • Marc Gorayeb, MD

    Translation of the post:
    Please; leave all this hard stuff to us reasonable, objective, dispassionate technocrats.
    My reaction:
    Elitist, nose-in-the-air condescension.

  • ninguem

    Paul Starr in his 1984 Pulitzer Prize-winning book, “The Social Transformation of American Medicine”:

    “Political leaders since Bismarck seeking to strengthen the state or to advance their own or their party’s interests have used insurance against the costs of sickness as a means of turning benevolence to power.”

  • gzuckier

    Imagine this scenario:

    Democrats and Republicans work hand in hand to pass the best healthcare bill in the world. It works better than anyone dreamed. Costs fall sharply and outcomes are better than ever. The public is thrilled. Obama is reelected by a landslide.

    At this point, all the Republicans in the audience say “Wait a minute. What?”