Yes, Let Government Control Medical Costs

"Centralizers," a conservative wrote disapprovingly in Reason magazine, "say that the responsibility for making tough decisions about how to keep health care costs under control ought to be made by enlightened, well-intentioned policy elites."

I don't know. These "elites" beat the heck out of corporate interests trying to sell me treatments I don't need or whose results can be duplicated at far lower cost.

Author Peter Suderman was touting "consumer-driven health care."  When people use their own money to buy health care, the theory goes, they are more careful about costs.   

One model for consumer-driven health care is a health savings account paired with a high-deductible insurance policy. The HSA lets people sock away pre-tax dollars to be spent on medical needs. What's not used that year can be invested for future health care costs. Should some super-expensive medical condition arise, the insurance plan kicks in (after the large deductible is met).

Sounds promising ... but. In reality, HSAs don't do much to control costs because the big spending occurs in the serious cases, after traditional insurance has taken over.

When trying to sell "privatization" to a wary public, conservatives often imply that government smarties look down on the little guy. Sure enough, Suderman accuses the elites of believing that "individuals cannot be trusted to make prudent decisions about their own health expenses."

Whoa. Now I can be "trusted" to shop for the lowest price. But how would I know whether Dr. Discount is a skilled practitioner or that a cheaper treatment would be equally effective? The person who must be trusted is the doctor, not the consumer. If my doctor say, "I don't like your indigestion, you need an endoscopy," do I don a white jacket and say, "Doc, shouldn't we try Tums first?" I would not.

Aha, say those who would strap consumers into the medical cockpit: You will have all the information you need to second-guess your doctors. It will be on the Internet.  Great. Let's treat stomach polyps with apple cider vinegar. (That's what they say at www.earthclinic.com.)

What patients and doctors need is a U.S. government website run by an enlightened, well-intentioned policy elite that studies various treatments for the same condition and compares their performance. That's how we can find effective, less costly care.

This is the point of comparative effectiveness research, and guess what? Republicans hate it. Information-wise, their backers in the medical-industrial complex want only their advertisers to stand between you and their products. For a sampling of the passions, almost-GOP presidential candidate Mike Huckabee called comparative effectiveness research "the poisonous tree of which death panels will grow."

"It's ironic that many of the strongest supporters of consumer-driven health care are opposed to comparative effectiveness research," Peter Orzag, former director of the White House Office of Management and Budget, told me. "Regardless of your vision, you need comparative effectiveness research."

One need not be a genius, or even an enlightened elite, to guess that once this information is out there, most payers will not shell out $50,000 for a course of chemo that produces no better results than an older kind costing $10,000. And here's where elements of consumer-driven health care can actually work:

Say the patient insists on getting the $50,000 treatment because it takes two hours less. The insurer (be it government or private) pays $10,000, and the patient comes up with the $40,000 difference. Thus, consumers have the freedom to obtain whatever expensive regimen they want, but others don't have to subsidize their extravagant care.

For most of us, however, "consumer-driven health care'' will mean that when the doctor says go get an MRI, the consumer drives himself to the clinic.

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