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How a dumb idea becomes a law

Commenter JD is appalled by how dumb our laws are.

Ezra, I find the following quote from the Courage article completely confusing and would be interested in your view on it:

"Under federal law, Courage's findings about efficacy can't alter the amount Medicare pays doctors for stenting. The government insurance program is legally barred from considering a treatment's benefits when deciding how much to pay doctors for doing a certain procedure. Private insurance carriers, in turn, generally base their rate schedule on Medicare's."

What kind of stupid rule is this? Where does it come from?

What kind of stupid rule is this? Well, JD, it's a good, old-fashioned American stupid rule, which is the best kind! The offending provision is on Page 376 of the Medicare Modernization Act (pdf), and my understanding is that similar legislation was adopted as part of the stimulus bill.

Where does it come from? Well, one answer is that it comes from Republicans who want to block rationing. But my understanding is that the more honest answer is that it comes from pharmaceutical and medical device interests who want to make sure that evidence that their treatments don't work as well as cheaper alternatives isn't allowed to interfere with advertisements and doctor outreach programs that imply their treatments work far better than cheaper alternatives. And in the face of this organized opposition, Democrats have largely backed down, hoping that the evidence will be sufficient to change practice standards and figuring that if they gather a lot of evidence, they can always allow Medicare to use it at some later date.

For more comment on this, see this old Steve Pearlstein column.

By Ezra Klein  |  February 12, 2010; 4:48 PM ET
Categories:  Health Economics  
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Posted by: steveboyington | February 12, 2010 5:04 PM | Report abuse

C'mon, Klein. I know you're a few bricks shy of the full load, but what you're implying is that the price of iPods should be proportional to the enjoyment one gets from the purchase. It's nonsense.

The price of a medical procedure should be in some way related to the cost of delivering the procedure, not hinged on some third party's opinion on the politics of the thing.

But, of course, as long as the collective is chewing its ignorant cud over such matters, the stupidest questions and concerns will adhere.

Posted by: msoja | February 12, 2010 5:06 PM | Report abuse

It's amazing to even think about: the government is prohibited from even attempting to find out if the medical treatments it pays for actually work.

Posted by: etdean1 | February 12, 2010 5:54 PM | Report abuse

Everyone deserves phamacologic treatment for coronary artery disease unless you are someone important like Bill Clinton.

Posted by: Jenga918 | February 12, 2010 6:59 PM | Report abuse

--"It's amazing [...]"--

What's amazing is that the government is allowed within a mile of healthcare.

Posted by: msoja | February 12, 2010 8:59 PM | Report abuse

Ezra deliberately misreads the study yet again. The COURAGE trial did not show an advantage for stents after 36 months. However there was an advantage (i.e. immediate relief of symptoms) prior to that. The advantage was greater the more severe the angina was. It's easy for a twenty-something to feel that immediate relief of chest pain is no big deal....

In Europe the PET trial couldn't even enroll enough patients because of the immediate vs. delayed pain relief in the two trial arms.

Uncle Bill had unstable angina. The COURAGE trial did not apply to his case.

Posted by: J_Bean | February 13, 2010 12:20 AM | Report abuse

It's ridiculous to argue that medicare - or anyone - should pay for treatments regardless of their effectiveness.

I subscribe to a few medical journals. They're full of studies showing no benefit to expensive interventions. Journal Watch's 2009 year-in-review was a case in point.

The more I learn about this stuff, the more I think the issue is not so much a lack of data. The issue is that some people - the same people screaming about socialism, it turns out - feel perfectly entitled to live parasitically off of taxpayers.

Posted by: jdworkin1 | February 15, 2010 12:06 AM | Report abuse

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