Tag Archives: evidence-based medicine

Cowen calls for evidence in health care options

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Yes, it’s been a little quiet here lately (other than comments about 9/11 being an inside job, and who knows what kind of traffic mentioning that will bring?).  The reasons are twofold:  first, I have been building a new business I started early last year; and second, I just launched a blog that describes my thinking about that business.  I’m very excited about both.

That said, PublicOrgTheory has been my first love for over five years, and I always come back to it.  This meditation by Tyler Cowen on health care caught my attention this morning:

Over at Twitter, Matt Yglesias asks:

Do rightwingers really believe that US health insurance has no mortality-curbing impact?

I don’t speak for “right-wingers,” but I’ll say this:

1. I genuinely don’t know what to believe.  And I often toy with the idea of an “innovation-maximizing” health care policy, so that future coverage is more effective.

2. I am commonly excoriated by people (not Matt) for not supporting government-subsidized universal health insurance, yet few if any of these people grapple seriously with the best evidence.

3. I live in a country where the extension of health insurance is a major issue, and a major budgetary issue, yet much of the discussion is in an evidence-free zone.

There’s more, but it was the evidence-based points that I found most compelling.  While I think coverage for all Americans should make for a healthier nation, an economically stronger nation, and a nation better prepared for its own defense, I have to agree with Cowen that no one–including myself–is offering up evidence that would support the plans being discussed.  There’s an opportunity to be seized here.

National debate seems to be one of the few areas left in American society–management and medicine being two notable others–in which evidence need not be the basis of an argument or action.  “Proving it” is a big deal among people whose lives and livelihoods hang in the balance.  It would be an excellent change to see that kind of urgency to “prove it” in all matters of national interest.

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Week in Public Organizations, 15Jun2009


Federal culture change, evidence-based medicine, GOP policing the GOP, secrecy in the administration, auto-immune warfare, spy vs. spy, vetting at the State Dept., and fast Finns.  These were some of the stories in the organizational realm last week:

Feds to attempt culture change at GM
Evidence-based medicine succeeds in Green Bay
GOP investigates BoA, ML deal
Obama administration presses for secrecy
Terrorism labeled “auto-immune warfare”
DNI, DCIA in turf squabble
State to review vetting procedures
Finns make rules for racing

Evidence-based medicine succeeds in Green Bay

A triumph for evidence-based medicine in Green Bay:

In the final two years of a patient’s life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Some differences can be explained by big-city prices, acknowledged Elliott Fisher, principal investigator for the Dartmouth Atlas Project, “but the differences that are really important are due to the differences in utilization rates.”

Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare — and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

One lesson:  numbers matter.  Tired N=1 arguments and “personal stories” don’t get to overall health, no matter how tragic and unfair they are (and I’m looking at you here, Michael Moore).  What is tragic and unfair is an overall system in which people who become ill through no fault of their own use emergency rooms as primary care facilities, which paradoxically adds to the cost burden of people who do not want to pay for comprehensive health services.  Indirect costs can easily exceed the modicum of investment that such a plan would require.

I’m not sure why people who cry “socialism” at the thought of ensuring a basic level of health in the most powerful nation in the world seem not to be bothered by a “socialist” education system that attempts the same for education.  Perhaps the message would be more palatable if stated in economic or national security advantages.

So, good for Green Bay.