Byline: Benjamin Zycher, SPECIAL TO THE WASHINGTON TIMES
Democracy is the art of wealth redistribution, a hard reality that creates losers as a necessary byproduct of policymaking. Taxing those other guys behind the tree, in brief, arouses their opposition, and as much as bureaucrats and politicians may enjoy bossing people around, the blowback can be intense.
Obamacare is coercion par excellence, a top-down exercise in central planning guaranteed to create vast numbers of enemies. At some point, federal officials face overwhelming incentives to shift authority - that is, the political heat - elsewhere. Witness, for example, the recent announcement that the list of medical services to be covered under Obamacare will be delineated by the individual states rather than the Beltway. Left unexplained is the question of why, if this partial decentralization is good, full decentralization to market forces would not be better.
Never mind. Let us consider instead the far-larger exercise within Obamacare to avoid responsibility: The law establishes a comparative effectiveness review (CER) process to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions.
Yes, we're the federal government and we're here to help you. Since government cannot pay for all medical services demanded, rationing of one sort or another cannot be avoided in a world of finite resources, regardless of all the mindless rhetoric about covering the uninsured. Expensive treatments will not be allowed; that is the essence of top-down cost control.
The Beltway, though, does not have patients. Instead, it has interest groups engaged in a long twilight struggle over shares of the federal budget pie. Less for one group means more for others, and even modest reductions in the huge federal health care budget are tempting for other constituencies.
In other words, there can be no such thing as unpoliticized science inside the Beltway. It is inevitable that political pressures will lead policymakers to use the findings yielded by CER analyses to influence decisions on coverage, reimbursement or incentives within Medicare, Medicaid and other federal health care programs.
This will be bad enough for patients in the here and now. Instead, consider the effects on future investment in new and improved medical technologies, examples of which are pharmaceuticals and medical devices and equipment. No one can know in advance either how CER analyses of interest will turn out or how the findings will be used. Indeed, the uncertainties are enormous. The findings of statistical analyses are driven in substantial part by the design of the underlying studies. Such studies always will conflict to some degree, introducing considerable subjectivity into the process of deriving conclusions from the CER process. …