John B.,

I think you are right. But if John G. is right too, about medical cost effectiveness as we both think he is, AND if he is effective in getting the word out, then the cost savings to private or publicly provided insurance, from streamlining the care package, will, IF AND AS his message is understood, begin to outweigh in buyers/voters eyes, the current “feel good” effects of all the unnecessary preventive care built into so many plans now. The world will, with education like his, become a better place.

What you and I have done for so long, and John G. too, is to help make the real world safer for people proposing more efficient, honest and principled solutions. And he’s doing it, even as he fights the bad information we have all operated with for decades. You and I have been there and done that, sometimes alongside John G., as any good policy analyst does daily. Agreed?

Yet what you said does help explain why we get some of the bad proposals out there–smart or instinctive politicians, but short-sighted and typically lacking the patience and perseverance to lead in the way as John G. is doing.

I have no doubt you’re correct. However, consider the Park Service’s “Golden Age Passport”. It gives lifetime admission to the entire Park system for $10! Is the Park Service stupid? Strategic?

I’d bet the latter. What are the attributes of those who buy the Passports? Not random for sure. Consider correlates with voting patterns. I’d guess the same variables hold for those using preventative care and think it’s likely that this has political implications highly relevant to health care reform.

While efficiency may be a Schelling point, it’s hard to mobilize people to march under its banner.

Just a random thought.

Whereupon then Republican Senatorial candidate Bernadine Healy, M.D., just retired as head of the NIH, published an op-ed piece in the Wall Street Journal accusing the Clintons of proposing to ration health care. Because the Wall Street Journal editorial page publishes generally only views with which the editors agree, I presume that they bought into that argument.

And that explains why it is so hard to make sensible health policy in this country and why we spend as if there’s no tomorrow. Note that AdvaMed and Pharma succeeded in having the language in the stimulus bill this month changed from “comparative effectiveness analysis” (which might include a consideration of costs) to merely “comparative clinical effectiveness analysis,” to preclude cost-effectiveness analysis. To them John Goodman sounds like a Communist.

More importantly, though, I do not believe that Johnny Cash was actually playing his guitar in the piece John posted. You can’t run your hand up and down the board so casually the way he does and get sensible tones out of a guitar. There must be a law against that kind of deception. Might this be the basis for a class action suit, to get our money back on the CDs we bought?

Uwe Reinhardt

Cigarettes: Chill you out.

Beer: You can have a daily six pack without working out.

Cheeseburgers: Taste better than veggie burgers

Maybe Obama can just get us a Huey Lewis “New Drug.”

A major difference between a private and a public system is that in a private system they develop profitable options that are appealing, but not cost effective. Annual physicals are one of those things. It’s something you can see and use right away. Marketers feel that if people aren’t “using” their plan, they won’t see the value in it.