Socialized Medicine (reply)

[D-]> Evidence-Based Medicine will fade with more socialized medicine. The
> bureaucratic committees and legislative sessions of socialized medicine
> will base decisions more on a consensus of what can be believed as right
> and wrong, and rely less on what is provable, probable or fallacy.

[BR] Socialized medicine exists in several countries around the
world. Are there any data to support the above assertions?


[D-] My assertion is that when there are public representatives, politicians, and delegates making the decisions about what is and is not provided as medical care, scientific analysis will tend to take a back seat because these people are accountable to the general will of their constituents. These decision-makers must ultimately choose the popular decision among those who hold them accountable, whether or not it's based on evidence, or is fiscally responsible. A private carrier is accountable to it's members, employer groups, participating hospitals and physicians, and sometimes stockholders. Scientific evidence is the impartial trump-card used when a coverage decision is unpopular with the majority or minority who hold them accountable.

[D-]
>"Experimental" and "medically necessary" are touted as the evil tools of
>Health Insurance. Currently, and more so each day, these definitions are
>meticulously based on principles of EBM by Insurance Companies. But, be
>sure these "denials" will go-away with our new-found freedom in socialized
>medicine.
>
[BR] Again, is there any evidence for the above?

[D-]"Experimental" and "medically necessary" as tools for insurance villains to deny needed care are a theme I've read in reviews on the SiCKO film. Nevertheless, they are common and recurring expressions of disdain for private insurance companies when a claim is denied. That carriers use EBM in their definition of these terms is well-expressed in their documentation. BCBSA affiliates commonly use The Technology Evaluation Center analysis http://www.bcbs.com/betterknowledge/tec/tec-assessments.html, Aetna uses EBM in creating Coverage Policy Bulletins http://www.aetna.com/cpb/cpb_menu.html. That these elaborate mechanisms for creating coverage policy will go away with socialized medicine goes back to my first point. There is less accountability in socialized medicine and therefore less need for such elaborate and expensive systems, when it's much easier to base a coverage decision on the popular choice.

[D-]
> Which brings us back to having less use for EBM in socialized medicine.
>We have Medicare and Medicaid, and the VA system as current representatives
>of socialized medicine.

[BR] VAs associated with medical schools provide considerable
research. I've sat on some of those committees and know how busy the VAs get
doing research.

[D-] My assertion wasn't that these entities do not contribute to research. I should have been more succinct in stating that with just one (or three) huge bureaucracies in charge of all the healthcare payments, it becomes easier for those who want epic influence, or a piece of the overall pie, to focus in and "buy" it. With all the new control and power, I'm thinking it will be harder for the government healthcare bureaucracies to keep their focus (and funding) on such things as research enterprises. They will be too busy being manipulated by legislators, unions, and others with a stake in healthcare dollar.

[D-]
>What will qualifying everyone for one of these mean? If I'm a nurses union,
>I probably gain more power to direct wages, hours, etc., and have more
>political clout in other health-related issues. Congratulations, California
>Nurses Association. Can we trust a nurse's union to back the science to
>determine coverage for health care? Based on the record of the ANA in
>backing science, I'd say it will be no more a priority than for any other
>political lobby.
>
[BR] Does the ANA exist to foster research? Do you argue they are
opposed to research or think it irrelevant?

[D-] The ANA exists for many of the same reasons other professional occupation associations exist. http://www.nursingworld.org/ In particular, the ANA has let EBM take a back seat to other motives in regards to their endorsement of therapeutic touch and healing touch. The ANA will continue to avoid any initiative that jeopardizes the support of their constituents, like any other political lobby. In socialized medicine, their voice is much louder than it is among the current hundreds (thousands?) of private health care institutions.

[D-]>>snip<<

[BR] Arguing by asking questions sheds no light but makes points,
again, without evidence.

[D-] Agreed. But, points that can be arrived at based on common sense or practical reasoning can be as credible as the well-referenced ones. My intent is to get new thoughts and ideas considered, not necessarily proved. Proponents of a US socialized medicine system don't seem to practically consider what will influence and drive the healthcare dollar in such a system. My assertion is that EBM will be less meaningful. Clinical trials are expensive. A popular vote can take the place of study results. EBM is not needed as an impartial arbitrator when practice and payment decisions are based on an accountability to the system rather than accountability to the payor and patient.

[D-] >>>snip<<<

[BR] Can you provide more information about the kind of system you
would prefer?

[D-] I mentioned in a prior post that I do not know where is the best place between federal-run healthcare and a total free market; the happy medium between socialism and anarchy. Hopefully, I don't let my established bias against socialized medicine prevent a true understanding where that is. At present, I see a benefit of our current system where the market holds provider, payor, and patient collectively accountable for the healthcare provided.

Respectfully,

dras