What’s an unnecessary medical test?

The New Neo Posted on by

Amidst all the wrangling on health care reform, one of the issues that often comes up is the elimination of unnecessary medical tests. Although everyone would probably agree that such a savings in cost and trouble would be a consummation devoutly to be wished, the question is: “unnecessary” according to whom, and how would this be determined?

“Unnecessary” is usually defined ex post factor, after all, as in: “A medical test that my idiot doctor ordered, which cost me a lot of money and no small amount of time and trouble and even perhaps pain, and turned up nothing in the end.” But at the time the test is ordered, many (perhaps even most) patients think it’s best to leave no stone unturned, and are pleased that their doctor is being so thorough.

Although we may want cost-effectiveness to be the criteria on which the “necessity” of such tests is judged for others, we tend to want no stone left unturned when it’s own or our loved ones’ health at stake. Cost-effectiveness evaluations tend to be very cold-blooded: “X” number of dollars per life saved or per life-quality improved, and those lives are not always measured the same, with the value of a young person differing from that of an old one. These calculations trouble a great many Americans, and are among the reasons most of us prefer to be allowed to choose among a variety of private health insurance plans, some of them more and some of them less restrictive than others.

And what about the medical reasons for these “unnecessary” tests? A certain test may be not be especially cost-effective, in the sense that there might be only a small probability that that particular procedure will turn up something in any one individual. But it might still be judged medically necessary to run that test if a doctor wants to practice good medicine in a difficult-to-diagnose case, to make sure to rule out a treatable condition that could be dangerous if left undiagnosed. Assuming that the insurance covers the test and it is not exorbitantly costly, such decisions are usually based on a balancing of the risk of side effects or damage to the patient as a result of the test vs. the probability of its uncovering something treatable. That’s a different sort of cost/benefit evaluation.

And then there’s another definition of “necessity,” one we patients often ignore but one that is quite important to the doctor: the need of the medical professional to cover him/herself against lawsuits. This is one of the dirty secrets of medicine that Obamacare refuses to address. Some portion of “unnecessary” medical tests are an attempt by doctors to stave off lawsuits by showing they exercised all possible diligence in diagnosis.

I can only conclude that anyone pretending that the elimination of unnecessary tests would be easy, is being neither serious nor honest about health care reform. And I’ve seen absolutely no evidence that would even begin to convince me that the task is the proper province of government, or that government would do a good job in making such judgments.

A video on Gatesgate that stands for itself

The New Neo Posted on by

[Hat tip: commenter “Darrell.”]

This woman, Kelly King, should run for President. She’s truly articulate, as opposed to the surface smoothness and careful word calibration of our President. And her affect matches her rhetoric; she burns with the slow fire of the knowledge that she’s telling the truth.

Let’s hear it for the olive race

The New Neo Posted on by

[Via Ann Althouse.]

It appears that Lucia Whalen, the woman who reported the two (race-unspecified) men breaking into Gates’s Cambridge house, would like to correct the record:

“Contrary to published reports that a ‘white woman’ called 911 and reported seeing ‘two black men’ trying to gain entry into Mr. Gates home, the woman, who has olive colored skin and is of Portuguese descent, told the 911 operator that she observed ‘two men’ at the home.”

Being of the olive persuasion myself, I’ve often bridled at being labeled “white.” And so I propose to that much-beleaguered good citizen Ms. Whalen (who has my sympathies for the unwanted and negative publicity her well-intentioned act has caused her) that we start a new racial classification hereafter to be known officially as olive.

How to sell health care reform, according to liberals

The New Neo Posted on by

I did a little reading yesterday about health care reform over at Matthew Yglesias blog. I was trying to learn the current liberal point of view on the subject.

Yglesias himself is frustrated at the American people, who don’t seem to understand (as he does) that what they really need is a fundamental change from a fee-for-service model for doctor reimbursement to one of salary-for-wellness. He cites seemingly contradictory data that says that Americans are satisfied with their own health care, and yet they feel that the system needs fundamental change and that rising medical costs are a threat to the economy.

Yglesias’s conclusion:

I just don’t really know what one is supposed to do in the face of public opinion data like that. Opting for the Barack Obama approach where you focus on reassuring people that the status quo won’t change too much seems like a smart play, even though the case for changing things a great deal is very strong.

I’m not sure whether Yglesias believes that Obamacare would in fact result in such a fundamental change and that, in order to sell it to the American people, Obama needs to dissemble; or whether Yglesias is chiding Obamacare for not going far enough to cause fundamental change, and therefore he believes Obama’s reassurances to be the truth.

At any rate, I don’t see anything in Yglesia’s piece (and only a single comment in the entire thread) that appears to understand the basic problem the American people have with Obamacare: they may want change in health care, but they want it to be for the better rather than for the worse. They want the freedom to make the important choices themselves, and they deeply distrust government’s ability to bring greater efficiency and cost-saving to the system (fearing that not only will the savings be illusory, but they will occur at the cost of Draconian and unwelcome rationing), as well as being mighty suspicious of the Democrats’ undue haste in trying to pass this enormous and life-changing bill so quickly. Those are the things that make the vast majority of Americans wary, not some sort of love of fee-for-service over salaries.

I haven’t done any other reading at Yglesia’s on the subject, so perhaps he does acknowledge these issues somewhere. But I found it remarkable that, in the thread I did read, issues of choice, liberty, distrust of government intrusion and government inefficiency, and distrust of the speed of the bill and its lack of transparency were difficult to find in either the post or the comments section (except for the inefficiency argument, which surfaces briefly in comment 6).

On the other hand, strongly present in both the article and in many of the comments was the idea of the American people’s stupidity and/or cluelessness, their ignorance about what’s best for themselves (something the blogger and most of the commenters profess to know). The entire thread reminded me of the way liberals often tend to talk about “the people” when amongst themselves—like Obama at the San Francisco fundraiser speaking of the bitter clingers.

The condescension is palpable:

The public at large doesn’t know the difference between fee-for-service and capitation, and probably wouldn’t care.

The trick is selling this change so it doesn’t frighten people. I would do it this way:
– tell people that you’re going to abolish co-pays and deductibles – “you’ll never have to pay anything but a premium.”
– tell them you’re going to pay doctors extra for improved outcomes – “we’re going to pay doctors more for making people better!”

Then turn round and trade the AMA non-profit Federal no-fault malpractice insurance in return for not causing a fuss.

See also this:

Americans don’t want insurance reform. they want premium control and protection from cancellation. They want the same amount or more stuff for less money.

That’s fine on an interim basis. I just hope that at some point, people figure out that true slash-and-burn reform is going to be needed, meaning that insurers get purged, doctors see their pay cut and patients be forced to use low-cost options (non-emergency clinics, pharmacists with expanded authority, etc.) for most issues before running off to their GP’s or high-cost specialists.

Several of the comments display what I regard as a deeply naive trust of the government (see this):

I think a government-run healthcare service ”“as competition to the private sector ”” is ESSENTIAL. Not just for the benefits of competition ”“but because it will also provide the government with deep insight into the inefficiencies and bottlenecks of the existing system. It will help the government determine how best to design an integrated medical information system , for example, that will detect overcharging, poor care, fraud and waste.

And then there’s the need to increase the grip of the nanny state over the lives of those who display insufficiently responsible health habits (see this):

Patients definitely need to become more responsible – the obesity rate in our country is huge concern and a huge drain on our medical resources.

Even if we ignore the coercive aspects of how this might be accomplished—good luck with that one, since doctors have no idea how to make people lose weight, short of gastric bypasses for the select few.

When Yglesias wonders why “Obama has forgotten” to sell the idea of a “comprehensive healthcare system that would never cost them a cent beyond their (likely lower than at present) premiums,” my answer would be that maybe it’s because “the people” are actually smarter than that. Perhaps those folks who so bitterly cling to their current health insurance realize that they would be paying through the nose for the new system—and not just in premiums, but in skyrocketing taxes (as do “the people” of Europe, big time). And in liberty—but hey, who cares about that?

Obama achieves bipartisanship at last

The New Neo Posted on by

Obama finally has achieved a certain measure of bipartisanship. The only thing is—it’s in opposition to his health care reform bill.

If a party with the huge majorities the Democrats enjoy right now in Congress is having trouble passing a bill, maybe that should be a clue that there’s something seriously and perhaps critically wrong with it. It seems that this particularly bitter pill that Obama and Pelosi are asking Congress to swallow comes in both red and blue.

[NOTE: James C. Capretta and Yuval Levin at the Weekly Standard point out some of the major drawbacks of Obamacare. In sum: “paying more for a worse health care system.”]

Required reading on Honduras

The New Neo Posted on by

Maybe President Obama can find a moment in his busy day to take a look at this WSJ piece, wherein new Honduran president Roberto Micheletti gives the former constitutional law lecturer a Con Law lesson.

Read the whole thing; it’s well worth it. But here’s a brief excerpt [emphasis mine]:

Like America, our constitutional democracy has three co-equal and independent branches of government””a fact that Mr. Zelaya ignored when he openly defied the positions of both the Supreme Court and Congress. But we are ready to continue discussions once the Supreme Court, the attorney general and Congress analyze President Arias’s proposal. That proposal has been turned over to them so that they can review provisions that impact their legal authority. Once we know their legal positions we will proceed accordingly.

The Honduran people must have confidence that their Congress is a co-equal branch of government. They must be assured that the rule of law in Honduras applies to everyone, even their president, and that their Supreme Court’s orders will not be dismissed and swept aside by other nations as inconvenient obstacles.

Prominent among those “other nations,” of course, is our own, to Obama’s unending shame. Perhaps lawyer and Con Law scholar Obama might some day be able to articulate the reasons why he felt the need to so flagrantly ignore the rule of law and distort the facts in Honduras. Till then, I suppose we’ll just have to guess.

Mark Steyn takes on Gatesgate

The New Neo Posted on by

Mark Steyn has a few choice words about Obama and Gates:

The president of the United States may be reluctant to condemn Ayatollah Khamenei or Hugo Ché¡vez or that guy in Honduras without examining all the nuances and footnotes, but sometimes there are outrages so heinous that even the famously nuanced must step up to the plate and speak truth to power. And thank God the leader of the free world had the guts to stand up and speak truth to municipal police Sgt. James Crowley…

Professor Gates seems to go around with his Prejudometer permanently cranked up to 11: When Sgt. Crowley announced through the glass-paneled front door that he was here to investigate a break-in, Gates opened it up and roared back: “Why? Because I’m a black man in America?”

Gates then told him, “I’ll speak with your mama outside.” Outside, Sgt. Crowley’s mama failed to show. But among his colleagues were a black officer and a Hispanic officer. Which is an odd kind of posse for what the Rev. Al Sharpton calls, inevitably, “the highest example of racial profiling I have seen.” But what of our post-racial president? After noting that “‘Skip’ Gates is a friend” of his, President Obama said that “there is a long history in this country of African-Americans and Latinos being stopped by law enforcement disproportionately.” But, if they’re being “disproportionately” stopped by African American and Latino cops, does that really fall under the category of systemic racism? Short of dispatching one of those Uighur Muslims from China recently liberated from Gitmo by Obama to frolic and gambol on the beaches of Bermuda, the assembled officers were a veritable rainbow coalition. The photograph of the arrest shows a bullet-headed black cop ”“ Sgt. Leon Lashley, I believe ”“ standing in front of the porch while behind him a handcuffed Gates yells accusations of racism. This is the pitiful state the Bull Connors of the 21st century are reduced to, forced to take along a squad recruited from the nearest Benetton ad when they go out to whup some uppity Negro boy.

Read the whole thing.

Obama and Gates and Crowley: dialogue and construction and racial profiling

The New Neo Posted on by

Now we hear that Obama is going to get Gates and Crowley together for a White House chat. It’s an opportunity for a nice teaching moment about racial profiling, too, with Gates saying that “…he hoped his arrest by Crowley leads to greater sensitivity on racial profiling and that it was time to ‘move on.'”

Yes, let’s. Only trouble is, this case had nothing to do with racial profiling by Crowley. That’s the “construction” Gates put on it from the start—and after all, construction is his specialty, as is identity politics:

As a literary theorist and critic…Gates has combined literary techniques of deconstruction with native African literary traditions; he draws on structuralism, post-structuralism, and semiotics to textual analysis and matters of identity politics.

So I doubt Gates will be listening when I say the following:

Racial profiling occurs when police use racial criteria to target and/or stop suspects. Gates was a suspect because a witness had seen him break into a house, not because of his race, and he should have welcomed and thanked Officer Crowley for being so quick to respond to a possible break-in, instead of immediately using racial profiling to scream at Crowley and call him a racist for doing his duty. And if Gates had then “moved on,” as he should have, Crowley would have done so as well.

And then President Obama compounded the error by saying the police acted “stupidly” in the matter. That adverb should have been reserved for Gates, and then for Obama, who both demonstrated racial profiling themselves. Therefore whatever “greater sensitivity to racial profiling” is needed, it’s on the part of Obama and Gates rather than Crowley or the Cambridge police department.

But don’t sit on a hot stove till the press—or Obama or Gates—sees it that way. And now, can’t we all just get along?

[ADDENDUM: A previous post of mine on racial profiling—albeit in a different context—is here.]

[ADDENDUM II: And this non-PC joke by commenter gcotharn is quite on target:

Our nation will take a step forward when we reject PC and make jokes about BAPs, i.e.

How many Black American Princesses does it take to change a light bulb?

Nine.

One to change the light bulb. One to scream out “racist society” to the neighbors. One to berate the black police officer on the scene. One to berate the Hispanic Police Officer on the scene. One to call the (black) Mayor. One to call the (black) Governor. One to call the (black) President. One to begin booking the talk shows. One to start production on the documentary film.

It’s a joke, but embedded within it is a serious observation: here we have a black Harvard professor quick to cry “racism” about a group of police officers of mixed racial background, in a city with a black mayor, in a state with a black governor, in a country with a black President.]

Obama on Afghanistan: victory is a four-letter word

The New Neo Posted on by

I’ve got a post up at American Thinker on the topic of Obama’s distate at the notion of “victory” in Afghanistan, and American “victory” in general.

Feel free to join in the comments section there and/or here, as you wish.

After you read the piece, though, please come back here and read the following addendum. Space constraints prevented me from adding it to the original article:

For those interested, here’s a more complete account of the signing at the Japanese surrender. The Japanese dignitaries who signed did so in the name of the Emperor, who was not present. But although MacArthur presided, the US was hardly the only country to whom the Japanese surrendered—remember, we fought as one of the Allies, albeit a very important one.

Note, also, the symbolic presence at the signing ceremony of the flag commemorating Japan’s attack on Pearl Harbor that marked our entry into the war against that country. How much does Obama, a Hawaiian, even know of the sneak attack on the base at his own state, and the fact that in fighting WWII on the Asian front we were responding to Japanese aggression? Our victory over Japan was extremely hard-fought, much desired, and very satisfying—although bittersweet, since it came at such a huge cost in suffering on all sides:

The signing ceremony took 23 minutes to complete, and was held aboard the battleship USS Missouri, anchored with other American and British ships in Tokyo Bay. Symbolically, the deck of the Missouri furnished two American flags. One had flown over the White House on the day Pearl Harbor was attacked. The other had flown the mast of Commodore Perry’s ship when he had sailed into that same harbor nearly a century before to urge the opening of Japan’s ports to foreign trade. The instrument was signed by the Japanese Foreign Minister Mamoru Shigemitsu “By command and on behalf of the Emperor of Japan and the Japanese Government” And then General Yoshijiro Umezu “By command and on behalf of the Japanese Imperial General Headquarters” at 9:04 am.

Afterwards, U.S. General Douglas MacArthur, Commander of the Southwest Pacific and Supreme Commander for the Allied Powers, also signed. He was followed by Admiral Chester Nimitz for the United States, Hsu Yung-Ch`ang for the Republic of China, Bruce Fraser for the United Kingdom, Kuzma Derevyanko for the Soviet Union, Thomas Blamey for Australia, Colonel Lawrence Moore Cosgrave for Canada, General Philippe Leclerc de Hautecloque for France, C.E.L. Helfrich for the Netherlands, and Leonard M. Isitt for New Zealand.

The document, prepared by the U.S. War Department, set out in 8 short paragraphs the complete capitulation of Japan. The opening words: “We, acting by command of and in behalf of the Emperor of Japan.” signified the importance attached to the Emperor’s role by the Americans who drafted the document. The short second paragraph went straight to the heart of the matter: “We hereby proclaim the unconditional surrender to Allied Powers of the Japanese Imperial General Headquarters and all of Japanese armed forces and all armed forces under Japanese control wherever situated.” The document demanded that Japan “carry out the provisions of the Potsdam Declaration and free all Allied prisoners of war.”

Fisking the Obama “apology”

The New Neo Posted on by

I don’t have to spend a lot of time at it, since John at Powerline has already done a fine job.

But I would like to add just a little tidbit concerning the following sentence of Obama’s:

And I could have calibrated those words differently…

Note the word “could.” That’s a very subtle qualifier, a weasel word extraordinaire. The word Obama should have used is should, as in “And I should have calibrated those words differently.” “Could” means essentially nothing; merely the capacity to do something, not any need to do it.

The trouble with the word “calibrated” is also massive, but some of this was dealt with by Powerline already. Suffice to say that Obama is being is way too “calibrated” about his words at this point. Words mean something, especially ones like “stupidly.” They are not all ambiguous or arbitrary, except to a Humpty Dumpty like Obama:

[T]hat shows that there are three hundred and sixty-four days when you might get un-birthday presents ”” ”˜

`Certainly,’ said Alice.

`And only ONE for birthday presents, you know. There’s glory for you!’

`I don’t know what you mean by “glory,””˜ Alice said.

Humpty Dumpty smiled contemptuously. `Of course you don’t””till I tell you. I meant “there’s a nice knock-down argument for you!””˜

`But “glory” doesn’t mean “a nice knock-down argument,””˜ Alice objected.

`When _I_ use a word,’ Humpty Dumpty said in rather a scornful tone, `it means just what I choose it to mean””neither more nor less.’

`The question is,’ said Alice, `whether you CAN make words mean so many different things.’

`The question is,’ said Humpty Dumpty, `which is to be master””that’s all.’