In today’s Dose:
Health care reform
(Bipartisan support looks unlikely; Public option)
Health news
Medical research grants)
Health care reform
- As members of Congress headed home for a week-long Fourth of July recess, the consensus on health care reform legislation is that it will not be bi-partisan, as Obama and Democrats had hoped. Republicans are firmly opposed to the public option, despite its support by the public. Ohio Representative John Boehner said he did not know of any Republican in the House who supported legislation as proposed so far. Similarly, North Carolina Senator Richard Burr, asked how many Senate Republicans would sign the Democrats’ plan, said “I think right now, none. Zero.”
Of course, this could be strategic posturing, designed to win concessions. This gloomy picture is described in a NY Times story, “Little Hope for G.O.P. to Support Health Bill.” Republicans, such as Iowa’s Charles Grassley, say it’s not a bipartisan bill with only three or four Republicans. Democrats say it will be sufficient if there are enough Republican votes for legislation to pass.
Regardless of what the public may want, and what’s in the interests of the country, realistically this is a political battle.
Democrats say the Republicans’ stance reflects a calculation by the party leadership of the political danger in allowing Democrats to score a victory on health care as well as a fundamental misreading of the national mood.
- The Economic View column in today’s NY Times lays out the opposition’s arguments against a public option. It’s by N. Gregory Mankiw, the macroeconomist who was chairman of President Bush’s Council of Economic Advisors. His main objection is that a public plan would ultimately have taxpayer support.
Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider. We don’t need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices. …
[I]f a public option is available, it will probably enjoy taxpayer subsidies. Indeed, even if the initial legislation rejected them, such subsidies would be hard to avoid in the long run. Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed — correctly, as it turned out — that the federal government would stand behind Fannie’s and Freddie’s debts, and this perception gave these companies access to cheap credit. Similarly, a public health insurance plan would enjoy the presumption of a government backstop.
Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance. Instead, the public plan would likely undercut private firms and get an undue share of the market. …
The largest existing public health programs — Medicare and Medicaid — are the main reason that the government’s long-term finances are in shambles.
Not true. Medicare and Medicaid have an uncertain financial future because the U.S. does not have a decent health care system.
True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending.
Sure, as if the private sector was controlling wasteful spending. Have you read the New Yorker lately? Or listened to something other than Limbaugh and FOXNews?
He then goes on to argue against a single-payer system, which he believes is inevitable if we go the public option route. After raising the dreaded ‘R’ word, rationing, he goes on to throw ice cold water on our hopes for health care reform.
If the government has a dominant role in buying the services of doctors and other health care providers, it can force prices down. Once the government is virtually the only game in town, health care providers will have little choice but to take whatever they can get. It is no wonder that the American Medical Association opposes the public option. … Over time, society would end up with fewer doctors and other health care workers. The reduced quantity of services would somehow need to be rationed among competing demands. Such rationing is unlikely to work well. …
In the end, it would be a mistake to expect too much from health insurance reform. A competitive system of private insurers, lightly regulated to ensure that the market works well, would offer Americans the best health care at the best prices.
I do think there’s an argument against single-payer, and that’s the one by Maggie Mahar that I mentioned yesterday: Under single-payer, our health care options could be jeopardized if a George Bush or Margaret Thatcher were elected to the White House.
Health news
- Gina Kolata is my favorite science writer. She has a story in today’s NY Times on research grants from the National Cancer Institute. The first sentence describes a grant for a study on taste and dieting. Do people who are especially responsive to the taste of food struggle the most to stay on a diet?
You’re meant to react: “Isn’t that ridiculous, that anyone would waste money on that?” But I’d really be interested in that study. I assume it’s about supertasters.
Kolata’s point is a good one, however. Too many grants are awarded for safe, insignificant research. Not enough money goes to those research projects that are a bit risky, but promise big returns.
[T]he fight against cancer is going slower than most had hoped, with only small changes in the death rate in the almost 40 years since it began.
One major impediment, scientists agree, is the grant system itself. It has become a sort of jobs program, a way to keep research laboratories going year after year with the understanding that the focus will be on small projects unlikely to take significant steps toward curing cancer. …
The problem, Dr. [Robert C.]Young and others say, is that projects that could make a major difference in cancer prevention and treatment are all too often crowded out because they are too uncertain. In fact, it has become lore among cancer researchers that some game-changing discoveries involved projects deemed too unlikely to succeed and were therefore denied federal grants, forcing researchers to struggle mightily to continue. …
Dr. Raynard S. Kington, acting director of the National Institutes of Health … “the system probably provides disincentives to funding really transformative research.” …
“The problem in science is that the way you get ahead is by staying within narrow parameters and doing what other people are doing,” Dr. [Otis W.] Brawley said. “No one wants to fund wild new ideas.” …
Dr. [Richard D.] Klausner added: “There is no conversation that I have ever had about the grant system that doesn’t have an incredible sense of consensus that it is not working. That is a terrible wasted opportunity for the scientists, patients, the nation and the world.”
Research scientists are caught in a catch-22: They can’t get a grant unless they have preliminary results, and they can’t produce preliminary results unless they get a grant.
There also is new money from the federal economic stimulus package passed by Congress, which gives the National Institutes of Health $200 million for “challenge grants” lasting two years or less.
But the N.I.H. has received about 21,000 applications for 200 challenge grants, and researchers who have applied concede there is not much hope.
This is not the way to make scientific progress and achieve medical breakthroughs. In the rise and fall of medicine
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