DC Sharpshooters

Megan McArdle considers the problems with the PPACA’s “demonstration programs”: the administration’s analysts don’t seem that interested in analyzing the results.

4 comments… add one
  • steve

    Megan, like many people, is fixated on RCT studies. They are expensive and take a long time (usually). There is a trend in the literature to use IV studies to replace many of these, saving costs and letting us finance more studies. I suspect she doesnt have the stats background to understand this.

    What she keeps missing (she doesnt do retail medical) is that for the first time in 40 years, how long I have been in medicine, we are getting serious about costs. The HMOs in the 90s took a stab at it, but providers never got on board. Now, we know Medicare money to hospitals is going to be cut. I had a meeting this morning with some surgeons about how we are going to save costs by making processes more uniform and streamlining things. Of note, my partner and I had presented a similar, but not as extensive plan almost ten years ago. The hospital largely didnt care. We were a revenue center. If tests were duplicated, they got paid twice by insurers. If the test was not really needed, they paid. Now that we are heading towards becoming a cost center, they are eagerly listening and pushing us to work faster.


  • jan


    You seem to process your analysis of the PPACA anecdotally more than looking critically at the general design of this policy, — how it has malfunctioned and caused so much deception and chaos in people’s lives. This new HC has dramatically redrawn people’s HC delivery — changing doctors, hospitals, giving them coverage they don’t need for their particular age and stage of life, which for many includes dollar increases for unasked for, irrelevant services.

    However, what McArdle was questioning, was this:

    Gold’s article implies that the administration is looking at gross savings — which is to say, it’s just reporting the amount of money saved by the accountable-care organizations that ended up on the positive side of the ledger, even though this is less than half the total.

    The implication here being that there was a cherry-picking of positive/negative results in this Petri dish analysis of the PPACA, leaning towards selecting data that fit into the theory of savings seemingly offered by the PPACA’s implementation. It reminds me of how the linkage of cholesterol, fat in the diet and heart disease were initially linked together by Ancel Keys, in 1953. His findings were from the great Seven Countries Study, which dovetailed nicely into his thesis of the etiology of heart disease. However, what was not discussed was how he had 22 countries at his disposal, but only used the data from 7 — data that enhanced his own foregone conclusions of direct connections between dietary fat and heart disease.

    McArdle is only suggesting, with this piece, that the same kind of biased analysis went on with studies relating to the PPACA disingenuous and erroneous presentation of data, which were then able to support claims of cost savings through such a massive imposition of health care changes.

    BTW, I applaud you and your medical colleagues for staying on course to streamline procedures — those not needed or even duplicated. However, we both know that much of this is caused by increased litigation and physician fears — some of which could be addressed through much needed tort reform. Also, in bringing up unnecessarily duplication of procedures, this is akin to the unnecessarily criteria, created by the PPACA, massively applied to everyone in their HC policies, which then ratchets up the cost of that policy.

    Finally, there is much dispute as to what has caused the slow-down, even decrease of recent HC costs. Proponents, such as you, seem to lay it at the door of this new HC law. Others, though, attribute it to other factors such as the general slow down of the economy. However, whatever the cause may be, future fiscal predictions by the CBO are not bending the initial cost curve downward, but instead seem to be showing a distinct rise in costs, as well as most recently a loss of jobs, which then puts a damper on the economy.

  • steve

    jan- I have probably averaged an hour a day reading health care policy/economics for the last 5 years. If you want to talk policy, feel free. However, I find it is hard to get past people’s innate bias on these issues. I like to refer to what we are actually doing now to show some of the real effects of the ACA. Not all of them are good and not all of them are bad, but a lot of stuff is just made up. Most of those reports of huge increases in premiums end up being bogus. I know what is going on in my field and in my area of the country. I talk and meet with people in other areas of the country.

    To be clear, I have linked here to studies which showed that somewhere between 7%-25% of the slowdown may have been due to the ACA. I support malpractice reform not because it will cut costs much, it didnt in Texas, Florida or California, but because it will help with physician buy in.

    Finally, McArdle is actually making the well worn argument against pilot studies, but is a bit inconsistent about it. Trying to apply pilot studies is always a problem, but is how we often discover what to do. The central line initiative started as a pilot project at Hopkins, but is now a national standard of care. She said that if we are going to do them they should only be done as RCTs. Since she actually knows little about the medical field (and stats too I think), she doesnt know how expensive they are to conduct.


  • steve

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