The awesome power of Stayin' Alive . . .

. . . demonstrated yet again. As anyone who remembers anything I wrote here knows, should such a person exist, I have been practicing behavior modification on the New England Journal of Medicine for several years now. Every time they make an article of broad public interest open access, I feed them a bit of kibble; and every time they hide it, I hit them with a rolled up newspaper. The effort, I'm pleased to say, is paying off, and we're seeing more and more open material.

This week, they've really opened up with analyses on tobacco control, Medicare reforms and challenges associated with health care reform, including specific discussion of the Independent Payment Advisory Commission, a wonky but actually important discussion of how rules about paying for drugs in clinical trials create a problem for comparative effectiveness research, and even a fairly technical but not impossibly arcane discussion of Genomewide association studies. And oh yeah, the latest on limiting the work hours of residents.

The bad news is that Medicare payment policy and the other policy-related subjects are too damn complicated. When the public hears that Obama and a bunch of elitist eggheads are conspiring to "cut" Medicare that means putting Grandma on the ice floe, right? Actually the idea is to make her better off by:

• Making sure that less of the money spent on Medicare goes to fatten the profits of insurance companies and more of it goes to her health care;


• Making sure that specialists aren't overpaid so that there's more money for primary care docs and the other stuff she really needs;


• Making sure she gets the most effective drugs and other treatments, and that Medicare doesn't waste money on more expensive stuff that isn't any better, or on stuff that just doesn't work.

And oh yeah, making sure that Medicare stays solvent and the grandkids can afford the Medicare taxes. That's Donald Berwick's job, and it's because he really wants to do all that good stuff that he likes the National Institute for Clinical and Health Excellence and yup, rationing. And that's what makes him a bureaucrat-loving socialist mass murderer. Unfortunately once you get into the weeds on all this it doesn't fit on a bumper sticker, or even one of those extended 5 minute NPR reports. Katie Couric sure isn't going to explain it in 37 seconds. Start reading those articles I linked to and you'll see what I mean, if your eyes don't glaze over too quickly.

But I still think we can get the basic idea out there. More isn't better. What's better is the right stuff, the right priced stuff, for the right person at the right time. And that will end up being less, and being cheaper, and making us healthier and wealthier, just like they do in the grown up countries. Which the United States is not.