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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