Health Care

“It’s Now or Never”

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“If you want to make your voice heard on the health-care bill before the House votes on Sunday, you’d better do so quickly.” – Ed Whelan, NRO (via Instapundit)

Don’t stop calling even if the vote ends up passing the thing. I’m quite serious about this. Keep relaying your concerns, keep calling, keep at it. Actions should have consequences.

Update: Oh goodness, Instapundit is linking to this report of an incident in which serial phone calling to a Congressman’s office is interpreted as a form of harassment (Huh? How is that harassment? It’s about a specific bill that the Congressman is voting on ?)

Well, I certainly don’t want anyone harassed or treated in any way other than civilly and decently. I wonder, however, if such incidents are inevitable given that technology has empowered us “little people” (an Army of Davids!) to repeatedly call, or text, or fax our Congressman, while the low-tech Congressional side is nothing other than a person logging the calls or texts or faxes. I don’t think this dynamic is going to change any time soon, and in an odd way, highlights the problems with a central authority attempting to deal with such a complicated phenomenon as rapidly changing technology. It’s yet another illustration of why health care shouldn’t be managed by central authorities… .

“What people need to know is that Obama’s plan evades health care’s major problems and would worsen the budget outlook. It’s a big new spending program when government hasn’t paid for the spending programs it already has.”

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– From this Robert J. Samuelson article in the Washington Post (via Instapundit).

Many CB readers likely have read the above article, which does a nice job challenging certain aspects of the intellectual and policy “group-think” at the heart of ObamaCare. But never fear – I’m sure the same political class that sends its children to private schools in D.C. will cheerfully take its place in line with the rest of us should the “reform” fail to live up to expectation.

Update: Ezra Klein interviews Rep. Paul Ryan.

Mini-Book Review — Groopman — How Doctors Think

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Groopman, Jerome, How Doctors Think, Houghton Mifflin, 2007.

This book is several years old but deals with timeless subject matter that might be of interest to cb readers. In the past decade or two, a major initiative called evidence-based medicine (EBM) has tried to improve how medical research is conducted and how it is used in everyday clinical practice. It’s the application of the scientific method (with all its strengths and weaknesses) to confirming how we know what we know about medical practice. Some examples of such efforts “organized improvement” were covered in a book I reviewed earlier on cb called Better: A Surgeon’s Notes on Performance by Atul Gawande. Like Dr. Gawande, Dr. Groopman writes extensively for the New Yorker. The resulting quality and clarity of his writing in How Doctors Think stands out. Either he or his editors are very good.

In How Doctors Think, the author looks at a very different avenue of medical improvement. Deductive, evidence-based, medicine necessarily involves many patients and the careful collection of information about how a treatment works for large numbers of people. This is the foundation for proving the efficacy of particular treatments for particular populations, and winnowing out cases where doctors are “fooling themselves” about their treatment. Not fooling ourselves, as physicist Richard Feynman once pointed out, is one of the great challenges of science. The folks doing EBM research always give themselves a good laugh by evaluating the mathematical and statistical skills of the average GP. Interpreting the scientific medical literature is a real skill. One that needs to be taught and reinforced. As a baseline, we can aspire for a medical profession that can dependably read, critique, and interpret its own research.

The inductive process of forming a diagnosis and executing treatment with a specific patient benefits mightily from the disciplined research of EBM, but it by no means replaces the services of skilled physicians. Checklists or AI applications in medicine can reduce egregious errors, but human judgment, matched with experience and rigorous thinking, are necessary components of health care. And that’s the focus of Groopman’s book.

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An odd and jittery performance on Charlie Rose

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By the Speaker of the House of Representatives, that is. Did you see the interview with the good Speaker Pelosi? The normally placid environment (that solid wooden table!) is not so placid with said guest visiting. Petty to note, perhaps, but I felt as if I were watching a performance, and the performer was a nervous and jittery one.

Anyway, judge the quality of the interview for yourselves. Here are a few choice excerpts from the transcript at Real Clear Politics:

Pelosi: “People are more optimistic outside of Washington D.C. than they are inside of Washington. They want to — they want to be sure that we stick to our path which is to take us out of this economic challenge and not be afraid to do so” – What?

Pelosi: “When the president began and he said that he called for swift, bold action now. And the public responded to it in a very positive way. And he said in a very shall we say professorial way, but also inspirational way, we will harness the sun and the wind and the soil to fuel our cars and run our factories, and we’ll invest in science, have better healthcare innovation and schools for the 21st century.” – What?

Pelosi: “Universal healthcare. It’s a place where we are recognizing the damage to our planet by decision that said we have made that we need to reverse. It’s a place where we have to go — we had the industrial revolution, we have the technological revolution. Now we have to have a green revolution.” – What?

Pelosi: “I think there is a realization among all people that all the things we want to do, we need to think in public private — public, public, all different kinds of different combinations on how we get them done, so we can leverage our dollars in a safe way, but leverage our dollars so we get more than just the appropriate dollars.” – What does that even mean?

I could go on and on. What do you suppose she’s saying?

SUPER-DUPER MASSIVE AND IMPORTANT UPDATE: I screwed up – the link is to the 2010 Rose interview that I recently watched, while the excerpts are from the 2009 interview. I honestly did not pick up on that while reading the transcript, obviously. In my defense, here’s an excerpt from the correct transcript:

“It’s so historic. It’s so exhilarating to be part of
history that each one of us in the Congress is on the brink of making
history. This is Social Security, Medicare, health care for all Americans.
So it is its own — it has its own encouragement to it. ”

“It has its own encouragment to it.” Well, there you go. Make fun of me and my faulty memory, and her statement, in the comments. Or just me. Whatever.

Follow the House they all say….

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1. It’s worth reiterating something Rich and Jeff Anderson have pointed out: The focus on reconciliation in the past few days confuses things a bit. The question in the health-care debate at the moment is whether Nancy Pelosi can get enough of her members to vote for the version of Obamacare that passed the Senate late last year. If the House passes that bill, it will have passed both houses, will go to the president, and will become law. – Yuval Levin, NRO

2. So if, in the end, this process works as the White House wants it to work, it will do so because of core Democratic and liberal beliefs. Republicans and conservatives need to understand that; the political horror faced by every Democrat who does not have an entirely safe seat can be mitigated in part by the belief that there may be enough Democrats who can live their lives proud to have brought this measure to fruition. – John Podhoretz, Commentary