The New York Times Sunday Magazine has a lengthy interview with Obama this morning, focused on the economy. This is from the discussion on health-care reform:
THE PRESIDENT: First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being — that, I think, can be helpful.
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.
Q. And right now we’re footing the bill for a lot of things that don’t make people healthier.
THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (9) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
It's a very enlightening interview; a few things came to mind after reading it, the first being that provider incompetence is exacerbated by our present system. Sometimes doctors screw up because they're trying to push so many people through their office in the shortest possible amount of time. Under a for-profit system driven by volume, that's the most lucrative strategy.
So unlike the president, even though I usually go to top-notch doctors at excellent teaching hospitals, I always question their judgment. Anyone who stops asking questions does so at their peril.
The other is (and you may not know this), there are some important differences between some brand name drugs and their generic equivalents, mostly as a result of a patient's personal chemistry. It's also an open secret that drugs, brand-name or not, only work on some people. This quote from a GlaxoSmithKline VP a few years ago created quite a stir at the time:
"The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr [Allen] Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody."
And this is one of the reasons why I believe that anything short of a public plan will not be truly cost-effective. As long as a health plan is predicated on making money for the insurance and pharmaceutical companies, consumers will be short-changed.