is of course a paraphrase of the famous line uttered by Jack Nicholson in the movie "A Few Good Men." He was talking about the inability of the American public to deal with the dangers posed by external military threats.
My colleague at the Incidental Economist blog, Austin Frakt, has a great post up this morning about the story of bone marrow transplantation for breast cancer. It is a great post that looks at the practical application of research results to drive treatment decisions, and he terms the bone marrow treatment for breast cancer story a "tragic success" because a therapy that was once believed to be a miracle cure has been shown to be ineffective.
The first line of Paul Starr's brilliant history of medicine in the U.S, The Social Transformation of American Medicine, is as follows: "The dream of reason, did not take power into account."
There are many sources of power in the U.S. health care system that have the effect of assuming that all care provision must be good and in the best interests of patients leading to provision by default, but the most powerful and consistent source of power that serves to overwhelm the dream of reason is us. You and me. Our culture. As hard as the technical issues in developing data driven guidelines and evidence based medicine are, the biggest obstacle is our culture's inability to face up to the fact that we will all die. We want it to be the case that all care is beneficial, and so we assume it must be so.
That is why in Chapter 7 of my book "Balancing the Budget is a Progressive Priority" I propose a tax-based fail safe if proposed growth rate targets in health care are not met. Because people say in the abstract they want to address health care cost inflation, but are then opposed to anything that might have a chance of succeeding. A tax based fail safe would force the 308 million version of us to face up to the reality of the cost of our health care system. It might help us begin to demand a more evidence based health care system.
In class today we will talk about health reform as it fits into the long range budget situation of the U.S., and compare Republican alternatives to the ACA. How will we address both the aggregate costs of the system as compared to other spending priorities while not even having straight what works and what doesn't within the system? It is not an ideal way to go about it, but that is where we are.