American Elephants


Peter Orzag Recommends “Taylorism?” by The Elephant's Child

With an economy in crisis, Obama compared it, continually, to the Great Depression,and reached back to FDR’s economics for a solution.  Pelosi and Reid pushed through a huge Keynesian stimulus.  Republicans, completely outnumbered, refused to vote for the $860 billion stimulus.

Republicans tried to explain that Keynesian economics had never worked in the past, that incentives matter, and that the “multiplier effect” was a flawed notion, all to no avail.

Reaching back again to Britain’s establishment of the National Health Service just after World War II, Democrats were just sure that Americans would  love government-run health care as soon as they rammed it through Congress.

The proposed economics of the thing made no sense, but Democrats insisted that they had ways to reduce the costs.  Peter Orzag, President Obama’s former Office for Management and Budget Director wrote an opinion piece for the New York Times on the need for medical malpractice reform.  But tort reform has long been a Republican idea.

His approach has little to do with reform of legal practices. “What’s needed,” he says, “is a much more aggressive national effort to protect doctors who follow evidence-based guidelines.  That’s the only way that malpractice reform could broadly promote the adoption of best practices.”

Of course there are doctors who are not quite up on the very latest, but that is not what Mr. Orzag is talking about.  He has the illusion that “comparative effectiveness research” will deliver the best practice, and that all patients are “average” patients.  Sounds to me like another of those “progressive” ideas that they think are new.  Goes back to the “scientific management” of Fredrick Taylor (1856-1916).

It is impossible to develop single authoritative guidelines for every medical condition, let alone to trust any one entity to suddenly become the sole arbiter of what is acceptable medical practice.  Most improvements in the practice of medicine have  come about because some doctor did not follow accepted guidelines, but saw a better way.

Orzag testified before the Senate Finance Committee that “to alter providers’ behavior, it is probably necessary to combine comparative effectiveness research with aggressive promulgation of standards and changes in financial and other incentives.”  Under the Patient Protection and Affordable Care Act, Medicare will penalize hospitals through reduced reimbursement rates based on their performance on quality measures.

There you go.  This time they’re reaching w-a-a-y back.  Scientific management or “Taylorism” as it was called, said that decisions based on tradition or rules of thumb should be replaced by precise procedures developed after careful study of individuals at work, including time and motion studies.  Fredrick Taylor had  ideas of efficiency that are excellent in the development of specialized machines, but not so much in the control of enterprising, creative, independent, free Americans.

Democrats, or “progressives” as they prefer to be called, like to think of themselves as embracing progress, though they reached back to Woodrow Wilson for that designation. Since they believe that the wise people in government can do a superior job of ordering the affairs of the country, they end up being “control freaks.”

From Obama’s lecturing to the snide remarks of media pundits, examples of their lack of respect for the American people abound.  They love their ideas, and if we were as intelligent as they are, we would embrace them too.  Because their ideas are so good, they don’t need to examine how their ideas have fared elsewhere, nor do studies to estimate how they would work.

So they never realize that their ideas are old, tired and ineffective.

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4 Comments so far
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Haha, excellent repudiation of their claims that conservatives want to take us back to something.

Very informative post. Excellent. =)

Comment by fleeceme

[...] American Elephants – Truly thought-provoking piece about progressives and how they look to the past for guidance in the future [...]

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This is a creative blog post. It creates something from nothing – makes it seem like looking at evidence from past experience is a bad thing. Make working from theories of market fundamentalism appear to be better than working from experience. Market fundamentalism tells us that free markets are always better than publicly regulated markets. Every piece of evidence from the US and abroad says that conclusion is wrong. But the market fundamentalist’s theory says it should be right. So… voila! Let’s look forward and not backward! Let’s ignore the evidence and march right on to the utter collapse of American health care! Yea!

Second creation of this blog post: the author suggests that comparative effectiveness research “compares ‘average’ patients” to understand what works better for the typical person. What? Um, read the ACA. It explicitly charges PCORI to go beyond study of the average patient. For readers of this fantastical blog, you might go elsewhere for a reality based discussion of how CER aims to look at patients individually. CER and personalized medicine are complements, not combatants.

Try this blog, for instance:

http://www.sciencebasedmedicine.org/?p=8109

Or try an old post on mine:

http://thomasconcannon.blogspot.com/2010/03/on-comparative-effectiveness-research.html

Comment by Thomas Concannon

Goodness, did I say looking at evidence from past experience is bad? I thought I was saying that grabbing ideas from the past without fully understanding the evidence of how they worked or didn’t work is the problem. Obama’s main advisers for health care were, the press told us, Peter Orzag, Ezekiel Emanuel and Tom Daschle, all of whom were great admirers of Britain’s National Health Service. Oddly enough, the Brits are trying desperately to find a way out of the NHS, and are trying to put the doctors back in charge of a doctor-patient relationship. The same thing is going on in Canada. Government-run health care simply does not work anywhere. It works well-enough for those who don’t really need it; it’s the people who really need help that it fails.

I read your blog post and your CV. I fully understand that comparative-effectiveness research means well. It seems like it should work. But I have never seen any evidence that it actually does. As in any profession, there are some who aren’t up to snuff. For oncologists there are really hard decisions for both doctor and patient. But people are different. They respond differently to both medicine and treatment. The assumption is that the guardians of CER will look at lots of statistics and examples and know what treatments are best. But many of the great advances in medicine have come from doctors who stubbornly go with their instincts and deep knowledge to do things excoriated by their colleagues and directors and yet change the ideas of correct treatment permanently. An orthopedic surgeon friend of mine has done just that, and I know of plenty of other examples. The interesting thing is that CER decisions on what is “best” are not left up to the judgment of doctors, they are forced to comply. And if I have to choose between the advice of a physician or a statistician, give me the physician every time.

You say “Market fundamentalism tells us that free markets are always better than publicly regulated markets. Every piece of evidence from the US and abroad says that conclusion is wrong.” Market fundamentalism? How about government-run medicine fundamentalism? What an absurd statement. The miracle of Massachusetts health care has managed in just 3 years to make health care in MA the most expensive in the country. And if the federal government stopped bailing out your Medicaid would you be joining California and New York in bankruptcy? I’m afraid we’ll have to agree to disagree.

There’s something deeply wrong with a health care reform that wants to give healthy people unnecessary tests that will not establish whether they might get sick in the future (costing billions) while trying to find every possible way to cut any expenses of those who are sick or old and frail. Seems to me that the whole purpose of medicine was supposed to be to help the sick and frail, and you researchers just don’t get it.

Comment by The Elephant's Child




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