Politics

Poor Malia

Car and Pollster: I don’t even want to think about the intricate political calculations involved in picking out Malia Obama’s new car. The poor girl’s going to get stuck with a Cruze… Update: A Volt, you say? She’d be lucky to get a Volt. People who have them like them. But it seems a little upscale, and would remind voters of Obama and GM then-CEO Dan Akerson’s insane projections for electric vehicle sales. …

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Death Panels Live! In his Politico piece calling for a revival of Obamacare’s original end-of-life-counseling provisions, Harold Pollack blames “Palin, Bachmann and McCaughey” for having “dragged comparative effectiveness research (CER) into the broader partisan knife-fight over health reform.” But of course the main person who dragged comparative effectiveness into the knife-fight was Barack Obama, expounding on red pills vs. blue pills to David Leonhardt in the NYT months before Palin’s “death panel” gibe (and doing it again in subsequent speeches and statements). … Obama also put cost saving through “comparative effectiveness” squarely in the context of end-of-life decisions when he questioned whether his terminally ill grandmother should have been given a hip operation. (While Pollack  says end-of-life treatment is not one of the top targets for savings, Obama says it’s a “huge driver of costs.”) And Obama made it clear he favored a centralized effort to at least nudge doctors into dropping some treatments — and not such a democratic effort either:

Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. [E.A]

It was hardly crazy for Palin to worry that Obama’s “independent” Fed-like “comparative effectiveness” board –what is now the Independent Payment Advisory Board (IPAB) — might eventually evolve into a rationing institution like Britain’s controversial “NICE” panel.

Why did this discussion have to be part of the debate on extending coverage to the uninsured and security to the insured? A: It didn’t. But that was Obama’s choice, not Palin’s. “The critics have said, you’re doing too much, you can’t do all this at once, Congress can’t digest everything. I just reject that,” he told Leonhardt. In this case — given Obama’s failure to sell voters on his cost-cutting,  tough-choice-making ACA — it’s hard to say the critics weren’t right.

I could go on (Pollack has convenient fantasies about how wonderful it is for people to die at home, and about hospice care, which in my experience with actual patients in excellent Southern California facilities means precisely that your docs have given up on you and are now farming you out to lower-cost care provided by drive-by contractors. He also clearly thinks end-of-life consultations could result in large cost-savings even as he tries to deflect attention away from the topic.** [See Update below] And some honest, loving, non-euphemistic conversations are best not had, as generations of repressed WASPs, in their wisdom, have intuitively concluded.). But those topics are for a longer item.

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** Update: I based that on this passage in a 2009 New Republic piece by Pollack, in which he writes:

I recently noted an Institute of Medicine CER report. None of the identified high-priority items involved anything approximating the rationing of life-saving or life-extending care. End of life care ranked 28th in their chart of priority areas for CER research. This may be a mistake. Better approaches to palliative care often look very good when evaluated against the standard benchmarks of medical cost-effectiveness. [E.A.]

Via Twitter, Pollack says he doesn’t believe these better approaches will result in large cost savings. They are “promising” for CER (“costcomparative-effectiveness research”) but not for cost-cutting reasons. “Most valuable use of CER in EOL+palliative care is better quality of life.” Don’t tell Obama. … More: Pollack references this interview with Amy Berman for his perspective on palliative care. …

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From Politico‘s Playbook:

BIRTHDAYS:…  Luther Lowe, Yelp’s director of public policy, is 32, celebrating in Berlin

In my failed comedic novel of Washington, D.C., I really couldn’t have topped “Yelp Director of Public Policy.”

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