Sunday, August 23, 2009

A remarkable resemblance

[This is the second post in my series on “death panels”. The first post is here and contains definitions important to understanding the later posts. All posts in this series are categorized under “Death Panels”.]

While wandering through the landscape of the health care blogosphere, I stumbled upon this remarkably calm, remarkably intelligent article in the Washington Post. Danielle Allen’s “Opponents Are Prejudging Health Reform’s Side Effects” explains why worries about “death panels” and rationing cannot be assuaged by quoting chapter and verse of the legislation. Do read the whole thing but I was particularly struck by these two lines about the thinking of those who oppose Obamacare:

The issue, rather, is that they recognize that the stated goals and structure of a policy may not fully capture its full range of outcomes in practice. [snip]

In asking lawmakers to consider not merely the goals of their policies but also the experiential meaning of concrete realities that those policies may bring, they have a point.

This is remarkably similar to the reasoning behind Comparative Effectivness Research:

An important component of CER is the concept of Pragmatic Trials. These clinical research trials measure effectiveness—the benefit the treatment produces in routine clinical practice. This is different than many regularly clinical trials, which measure efficacy, whether the treatment works or not.

In other words those who are concerned about rationing and “death panels” are focused on what the real-world outcomes of Obamacare will be just as those who support Comparative Effectiveness Research are focused on what the real-world outcomes of medical treatments are. It is hard to understand why the idea that what happens in the real world isn’t always what we intended is so valid a concern in medicine but so ludicrous a concern in politics. If anything, we should expect there to be far, far less discrepancy between the predicted and actual outcomes in medicine than in politics.

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