Scientocracy

Why psychological science is relevant to policy debates—and what policies might look like if they were better aligned with human nature

Do Conservatives Like Excessive Medicare Spending?

The Wall Street Journal Praises High Cost of Care

An April Wall Street Journal editorial lauded the U.S. health-care system for giving American patients “more value—better outcomes and longer lives” than European health-care systems. The editorialist was praising a new study which, according to lead investigator Tomas Phillipson at the University of Chicago, demonstrated that “the costs of cancer care [in the U.S.] were indeed ‘worth it’.” 

 

Whether the study actually proves this point is debatable. The analysis found the biggest gain in cancer survival in the U.S., for example, in prostate and breast cancer, two cancers that are plausibly over-diagnosed in the United States. It’s easy to live a long time if your doctors find a pre-cancer and call it cancer. The investigators claim that they have taken care of this lead time bias by also looking at overall cancer mortality in the U.S. and Europe during the same time, where they find a dramatic reduction in prostate cancer deaths across the population. On the other hand, that analysis also finds a dramatic increase in stomach cancer deaths in the United States relative to Europe. As a physician, I have to say I cannot make much sense of these results. The authors don’t provide any good explanation for what U.S. physicians might have been doing (compared to their European colleagues) to increase prostate cancer survival so much, nor any idea what U.S. doctors were doing to so badly screw up the care of patients with stomach cancer. 

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Provocative research is much easier to believe when the investigators provide plausible explanations for the results. These researchers don’t do that. But that’s okay. This was still an excellent study, one that deserved to be published and one that deserves to be replicated and extended. No single study can answer every question. And certainly these researchers conducted some clever and thought provoking analyses. 

 

That doesn’t explain, however,  why the Wall Street Journal was so eager to applaud this study.  There’s lots of research, after all, which shows that the U.S. health-care system is uniquely wasteful.  =Plenty of studies, too,  showing that U.S. health-care providers charge a lot more than European counterparts for similar services. In addition, any good fiscal conservative must realize that the cost of U.S. health care is harming our country. Federal and local governments cannot balance their budgets, in no small part because of health-care costs. Individual citizens, too, find themselves financially burdened by expensive health care. 

 

Which leads me to wonder: Why would a conservative editorialist at the Wall Street Journal be so eager to embrace a provocative, but shaky, study that seems to encourage us to keep spending so much money on health care? Why would they feel that way?

 

I’d love to hear your thoughts. 

Peter Ubel, M.D., author of Critical Decisions and Free Market Madness, is a physician, behavioral scientist, and Professor of Business and Public Policy at Duke University.

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