Medicine is Sacred

The Patient Protection and Affordable Care Act is a federal statute that was signed into law in the United States by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010), the Act is the product of the health care reform agenda of the Democratic 111th Congress and the Obama administration. (more)

Better late than never, the New England Journal of Medicine:

The recently enacted Patient Protection and Affordable Care Act (ACA) created a Patient-Centered Outcomes Research Institute (PCORI) to conduct comparative-effectiveness research (CER) but prohibited this institute from developing or using cost-per-QALY thresholds. ,… The ACA’s language might be seen as symptomatic of the legislation’s aversion to policies that critics might see as enacting “big-government” health care or “death panels.” … The ACA … states that the findings of PCORI-sponsored research cannot be construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations. … The antagonism toward cost-per-QALY comparisons also suggests a bit of magical thinking — the notion that the country can avoid the difficult trade-offs that cost-utility analysis helps to illuminate. It pretends that we can avert our eyes from such choices, and it kicks the can of cost-consciousness farther down the road. It represents another example of our country’s avoidance of unpleasant truths about our resource constraints. (more)

Yup.  To the US public, medicine is a sacred; tradeoffs are taboo:

When people receive monetary offers for relinquishing a sacred value, they display a particularly striking irrationality. Not only are people unwilling to compromise sacred values for money—contrary to classic economic theory’s assumption that financial incentives motivate behavior—but the inclusion of money in an offer produces a backfire effect such that people become even less likely to give up their sacred values compared to when an offer does not include money.

Doesn’t sound promising for controlling costs, does it?

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  • 1) Kind of interesting that the cognitive bias at work here is thinking that medicine is sacred, but the NEJM author is the one demanding we put hard numbers on its results and make tradeoffs!

    2) The Scientific American finding doesn’t necessarily mean people are irrational in those cases — game theory (not to mention useful intuitions and motions) suggests that taking a principled stand can be necessary to secure good outcomes, such as to avoid traps like bait -and – switch – and – “but since you’re already here, you might as well …”

    3) By the way, I thought the NEJM just published stuff like biological research on humans, not political polemics?

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  • Rebecca Burlingame

    No, it doesn’t sound promising for controlling costs. But then, the idea that medicine is sacred suggests something else is going on, which might be a different incentive altogether for doctors. In a sense, money isn’t really the point in all this. Likewise: When I had a bookstore, I didn’t care if I made enough to pay the bills, I just kept the doors open as long as I could. My husband is back in the hospital now. But the doctors don’t look at him and go, you’ve already used up your umpteenth thousand dollars in Medicare! They are going to keep him alive, as long as they can.

    I think there are ways to get at these hidden incentives – the reasons people go ahead and do the work they want as long as they possibly can – that money has really botched up…till now.

  • I’m English and in the UK our National Health Service (NHS) is certainly sacred. It is almost universally regarded as one of the best things any govt ever did in the C20th, a modern day crown jewel, and a good-thing and – yes – any intrusion of money is regarded suspiciously as probably despoiling it.

    naively I used to imagine that this attitude was a british phenomenon related to the unique institution of the NHS itself. I used to imagine that the US system in particular was founded on cold rationality, and respect for the market. So the last two years of Obama’s struggle have been eye-opening for me: realising that ordinary americans view their (completely different) health system with precisely the same blind sentimenatality and loyalty that the british people do the NHS.

    So Robin, yes you are on to something. the organisation of Medical Services is not about health.

  • nick012000

    I, personally, am glad to see that Robin’s finally off of his Noble Savage kick.

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  • Opposition decreased, however, when the other side offered to compromise on a sacred value of its own, such as Israelis formerly renouncing their right to the West Bank or Palestinians formally recognizing Israel as a state.

    It follows that I must manufacture seemingly sacred values for use in future bargains.